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
- Psychological Treatment
- Depression Treatment
- Cognitive-Behavioural Treatment
- Rehabilitation Treatment
Somatic Treatment
Pharmacological treatment:
- Tricyclic antidepressants
- Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine and pregabaline.
- Tramadol
- Opioids
- Local anaesthetics
- Capsaicin cream
Other Treatments
Interventional Pain Treatments
- Local infiltration of the scar
- PRF-treatment of the scar
- PRF-treatment of a nerve root
- 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.