Shoulder / Arm

Scar Tissue Pain

Definition

Scar tissue pain occurs, for example, after an operation, and can result in chronic pain in and around the scar area.

Aetiology

The cause of scar tissue pain is damage to a small skin nerve, or when a nerve is squeezed by the scar tissue. In scar tissue pain, which can occur after an operation, there is sometimes mention of the formation of neuroma formation at the end of a damaged skin nerve. After some interventions, such as inguinal hernia, lung, heart, kidney, and shoulder operations, as well as breast amputations, scar tissue pain is more common.

Signs and symptoms

Patients with scar tissue pain typically complain of neuropathic pain, during which the pain is continuous, and alternates, with spontaneous attacks of stabbing pains in the scar area.  This pain can also occur after a complaint-free period lasting some months postoperatively.

Diagnostics

Physical Examination

Palpation of the scar can be very painful in small-defined areas (punctum maximum). Around the scar, a hyperalgesia and/or mechanical allodynia can be present.

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclic antidepressants
  • Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine and pregabaline.
  • Tramadol
  • Opioids
  • Local anaesthetics
  • Capsaicin cream

Other Treatments

Interventional Pain Treatments

  • In the case of therapy-resistant scar tissue pain, exploration by a plastic surgeon can be considered.

Invasive treatment

  • In the case of therapy-resistant scar tissue pain, exploration by a plastic surgeon can be considered.