Understanding Pain That Lasts After an Operation Has Healed
Chronic post-surgical pain is pain that develops or gets worse after surgery and lasts at least three months, beyond the expected healing time. It is surprisingly common after certain operations, including hernia repair, breast surgery, chest surgery, amputation, and knee replacement. It often involves a nerve that was stretched, cut, or caught in scar tissue. It is a recognized medical condition, and there are many ways to treat it.
Causes
Injury to small nerves during surgery.
Nerve entrapment in scar tissue or mesh.
Changes in how the nervous system processes pain after an injury (central sensitization).
Risk factors include severe pain before surgery, poorly controlled pain in the first days after surgery, and prior chronic pain.
Symptoms
Burning, shooting, or electric pain near the incision or along a nerve.
Numbness, tingling, or sensitivity to light touch.
Deep aching or pulling pain.
Pain with specific movements or positions.
Imaging Studies to Consider
Imaging depends on the surgery. Ultrasound can show nerves, scar tissue, and mesh and guide injections.
X-ray, CT, or MRI may be used to check for hardware problems, infection, or other surgical complications.
Nerve conduction studies can help when a specific nerve injury is suspected.
Physical Therapy, Home Exercise & Other Conservative Techniques
Physical Therapy
Scar tissue mobilization.
Desensitization techniques.
Graded strengthening and range of motion.
Home Exercise Program
Gentle stretching of the surgical area as directed.
A gradual return to walking and daily activities.
Other Studied Techniques
Transcutaneous electrical nerve stimulation (TENS).
Mirror therapy or graded motor imagery for limb pain after amputation.
Interventional Treatment Options
Targeted nerve blocks: For example, ilioinguinal or genitofemoral blocks after hernia repair, intercostal blocks after chest or breast surgery, or genicular nerve blocks after knee replacement. A block confirms which nerve is involved.
Radiofrequency ablation, pulsed radiofrequency, or cryoneurolysis: For longer-lasting relief after a successful block.
Hydrodissection: Fluid injected around a nerve caught in scar tissue.
Scar or trigger point injections.
Surgical referral: For hardware problems, mesh-related pain, or nerve removal in select cases.
Neuromodulation: Spinal Cord & Peripheral Nerve Stimulation
Peripheral nerve stimulation (PNS): A thin lead near the injured nerve. A temporary 60-day system is available for some conditions.
Spinal cord stimulation (SCS) and dorsal root ganglion (DRG) stimulation: Considered for severe pain that persists despite other treatment. DRG stimulation is well suited to focal pain, such as groin pain after hernia repair or knee pain after replacement.
Evidence Base: Guidelines & Levels of Evidence
Peripheral nerve stimulation: Level II · Randomized and prospective studies
Dorsal root ganglion stimulation: Level I–II · ACCURATE randomized trial (Deer et al., Pain 2017) for lower-limb CRPS and causalgia (nerve-injury pain)
Radiofrequency ablation / cryoneurolysis: Level III · Observational studies
Platelet-rich plasma (PRP): Not established · Not graded for this condition in the ASPN 2024 consensus guideline
Evidence levels and guideline citations above are summarized for general clinical reference based on the literature and major society guidelines available at the time of writing. Guidelines are periodically updated; please verify current recommendations before relying on this summary for clinical decision-making.
Pain Psychology Techniques
Cognitive behavioral therapy (CBT) for pain.
Acceptance and commitment therapy (ACT).
Pain neuroscience education about how the nervous system can stay sensitized after surgery.
Mindfulness-based stress reduction.
Graded activity pacing.
Non-Opioid Medication Options
Anti-inflammatory and analgesic options
NSAIDs or acetaminophen.
Nerve pain (neuropathic) medications
Gabapentin or pregabalin.
Duloxetine or a low-dose tricyclic antidepressant.
Topical treatments
Lidocaine patches.
Capsaicin 8% patch applied in the office.
Related Procedures
Related Conditions
Talk With Us About Your Options
Call 650-507-4113 or send us a message to schedule a consultation at our Daly City, Los Altos, or Stockton office. We will review what may be causing your pain and walk through the risks, benefits, and alternatives of each option with you.
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This information is provided for general patient education and does not replace individualized medical advice. Please discuss your specific symptoms, diagnosis, and treatment options with your pain management physician.
