Post surgical pain

Surgery is usually performed with the expectation that once healing is complete, pain will improve. For some people, however, the operation is successful but pain continues long after the tissues have healed. This can be confusing and frustrating, particularly when scans or surgical reviews suggest that everything appears satisfactory. Persistent pain following an operation is a recognised condition, and importantly, there may still be ways we can help.

Persistent post-surgical pain can occur after many different operations, including spinal surgery, joint replacement, hernia repair, abdominal or pelvic surgery, breast surgery, thoracic surgery and limb surgery. The cause varies considerably from one patient to another. Scar tissue may develop around sensitive structures, small nerves can become irritated or trapped, or the nervous system itself may remain unusually sensitive following the original operation.

The character of the pain often provides valuable clues. Some patients experience a persistent ache around the surgical area, while others describe burning, shooting, stabbing or electric shock-like pain. There may be numbness, tingling or extreme sensitivity around a scar, where even light clothing or gentle touch becomes uncomfortable. Following spinal surgery, pain may continue into the back or legs, while after other operations it may follow the pathway of a particular injured or irritated nerve.

My approach is not to assume that persistent pain means the operation has failed. Instead, the first task is to understand what is generating the pain now. I will review the history of your surgery, examine the painful area and consider previous scans or further investigations where appropriate. This helps distinguish ongoing structural problems from scar-related pain, nerve injury, muscular pain  or sensitisation of the nervous system.

Treatment is then tailored to the underlying problem. The main options can be grouped as follows:

Physiotherapy, rehabilitation and medication

● Individualised physiotherapy programmes to improve movement, strength and function

● Rehabilitation strategies to reduce pain-related disability and improve confidence in activity

● Carefully selected medications to target nerve pain, inflammation or muscle-related discomfort

Injections and minimally invasive pain procedures

● Ultrasound-guided peripheral nerve blocks to target specific irritated nerves

● Scar or trigger-point injections to reduce localised pain and sensitivity

● Pulsed radiofrequency treatment to modulate pain signals from affected nerves

Spinal and image-guided procedures

● Epidural injections to reduce inflammation around spinal nerves

● Selective nerve root injections to target specific irritated nerve pathways

● Racz catheter procedure (percutaneous epidural adhesiolysis) to address epidural scarring and improve access to affected nerve roots under X-ray guidance

Neuromodulation techniques

● Spinal cord stimulation for carefully selected patients with persistent neuropathic pain

● Techniques that work by modifying abnormal pain signalling within the nervous system rather than treating the surgical site directly

The important principle is that there is no single procedure for post-surgical pain. Treatment depends entirely upon understanding the mechanism responsible for your symptoms. Sometimes the most appropriate decision is an injection; sometimes rehabilitation or medication is more useful; and occasionally a more advanced intervention is required.

Persistent pain after an operation can make patients feel that they have reached the end of their treatment journey. Often, however, a specialist pain assessment provides a different perspective. My aim is to carefully identify why your pain has continued and develop a personalised treatment strategy designed not simply to reduce discomfort, but to help you move more confidently, sleep better, reduce reliance on medication and regain quality of life