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Chronic anal pain

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Female, 52 years old, complains of anal pain that lasts all day, but disappears during sleep, and aggravates during the day. The condition started 5 months ago, after a hemorrhoidectomy 1 year ago. Patient describes pain as burning and not related to defecation. Patient is diabetic and on oral glimepiride 2mg, with her blood glucose within controlled range. She is hypertensive and on oral captopril, with her blood pressure within normal range. She had a subtotal hysterectomy 6 years ago with no postoperative complications.

She was given local ointment to relieve the pain, plus a trial of pregabalin and gabapentin plus citalopram for over two months with no improvement. She also took amisulpride 50 mg for 2 months and corticosteroids for 1 week plus neurovit amps with no improvement.