Chronic Post-Surgical Pain

Chronic post-surgical pain can be due to a variety of factors and should be discussed with your treating surgeon. However, one of the causes could be injury to nerves at the site of the surgery. This can be an injury to a small nerve branch or to a larger nerve resulting in a neuroma, which is a painful ball-like growth at the end of an injured nerve. This can happen with any operation and patients with chronic post-operative “neuropathic pain” as described below should be evaluated for a nerve injury. Operations that are more commonly associated with nerve injuries causing chronic post-surgical pain include include mastectomy, chest wall surgery (such as a thoracotomy), hernia repair, hysterectomy, hip and knee joint replacement (arthroplasty), and amputation. While any injured nerve can result in neuropathic pain, commonly injured nerves include the superficial branch of the radial nerve, medial antebrachial cutaneous nerve, intercostal nerves, ilioinguinal nerve, iliohypogastric nerve, infrapatellar branch of the saphenous nerve, and superficial peroneal nerve. If you experience chronic post-operative neuropathic pain, it is crucial to be evaluated for a potential nerve injury.

If there is concern for an injured nerve being the source of chronic post-surgical pain, evaluation by a nerve surgeon may be beneficial. An injured nerve after surgery typically is diagnosed with a history and physical examination. The injured nerve often has an associated painful burning or tingling sensation known as “neuropathic pain”, and there may be a focal area of exquisite pain that when tapped causes shooting electrical sensations known as a “Tinel’s sign”. Often, a nerve block is performed with an injection of local anesthetic near the site of the suspected injured nerve. If this leads to significant relief of pain, then this typically is diagnostic of a nerve injury and suggests that surgical treatment would be beneficial. Of note, a local anesthetic injection provides only temporary relief and will not cure pain from an injured nerve; it is intended only to assist with diagnosis and treatment planning.

If a nerve injury is diagnosed, surgical treatment is generally recommended. This involves excising the neuroma and repairing the nerve end to the other cut end of the nerve, if identifiable. If not, alternative treatment options include burying the nerve deeper within the tissue to minimize irritation, targeted muscle reinnervation (TMR), or regenerative peripheral nerve interface (RPNI). While medications can help alleviate some of the pain associated with injured nerves, they do not provide a cure and should not be considered a long-term solution.

Recovery from the surgery is usually relatively quick. In most cases, the nerve pain should improve quickly. In some cases, the surgery may result in temporary increase in nerve-related pain before it improves. Surgery may also successfully treat the neuroma but result in “unmasking” of pain from other nearby neuromas.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with nerve-related chronic post-surgical pain from across the Bay Area and Northern California. Contact us to schedule a consultation.