Post-Surgical Pain Syndromes
Overview
Post-surgical pain syndrome (PSPS) refers to chronic pain that persists beyond the expected healing period — typically defined as pain lasting more than 3 months after a surgical procedure that is not explained by ongoing infection, malignancy, or another pre-existing condition. While all surgery carries some risk of persistent pain, PSPS is particularly associated with thoracic surgery, cardiac procedures, mastectomy, groin hernia repair, amputation, and spinal surgery. The condition is thought to involve nerve injury, central sensitization, and scar tissue formation at the surgical site.
Common Symptoms
•Persistent aching, burning, or shooting pain at or near the surgical site
•Allodynia — pain caused by normally non-painful stimuli such as light touch or clothing contact
•Hyperalgesia — an exaggerated pain response to mildly painful stimuli
•Numbness, tingling, or altered sensation around the scar
•Pain that interferes with sleep, mobility, or return to work
•Psychological sequelae including depression, anxiety, and pain catastrophizing
Common Causes
•Intraoperative nerve injury from cutting, stretching, or cauterizing nerves
•Formation of painful scar tissue (neuromas) at the incision site
•Central sensitization — the nervous system becoming persistently hypersensitized to pain signals
•Pre-existing chronic pain or high pre-surgical pain sensitivity
•Poorly controlled acute post-operative pain in the immediate recovery period
•Infection or inflammatory complications at the surgical site
Who May Benefit from Treatment
Patients who are 3 or more months beyond a surgical procedure and continue to experience pain at or related to the surgical site — and whose treating surgeon has cleared them of any active surgical complication — are appropriate candidates for an Echo PMR evaluation. This includes patients who have had spine, orthopedic, abdominal, thoracic, or other major surgeries.
Treatment Options at Echo PMR
•Nerve blocks — targeted anesthetic and steroid injections to interrupt the pain signaling pathway at the affected nerve or nerve plexus
•Trigger point injections — address painful muscular nodules and scar-associated myofascial pain around the surgical site
•Spinal cord stimulation (SCS) — modulates aberrant pain signals in the spinal cord and is highly effective for neuropathic post-surgical pain
•Peripheral nerve stimulation — a minimally invasive option for localized nerve pain at or near the surgical site
•Medication management — neuropathic agents (gabapentinoids, SNRIs, tricyclics), carefully managed analgesics, and topical treatments
•Interdisciplinary pain rehabilitation — integrates physical therapy, cognitive behavioral therapy, and pain psychology to address both the physical and psychological dimensions of PSPS
Recovery Expectations
Post-surgical pain syndromes are genuine, recognized medical conditions — not imagined symptoms — and they respond to appropriate treatment. While complete elimination of pain is not always achievable, the majority of patients managed with modern interventional and rehabilitative techniques achieve meaningful reductions in pain intensity, improved sleep, and greater functional capacity. Echo PMR sets individualized, realistic goals and tracks progress closely.
When to Seek Care
If you are living with pain that began after surgery and has lasted more than 3 months — and your surgeon has not identified an active surgical cause — it is time to consult a pain management specialist. Contact Echo PMR to explore a comprehensive evaluation and learn what options are available to you.