From the Research
Chronic pain after a TRAM flap procedure should be managed with a multimodal approach, prioritizing gabapentin or pregabalin for neuropathic components, as evidenced by the most recent study in 2025 1.
Management Approach
To address chronic pain after a TRAM flap, consider the following strategies:
- Nonsteroidal anti-inflammatory drugs like ibuprofen (400-600mg every 6 hours) or naproxen (500mg twice daily) for immediate relief, alongside acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) 2.
- Prescription medications such as gabapentin (starting at 300mg daily, gradually increasing to 300-600mg three times daily) or pregabalin (75mg twice daily, increasing as needed) for moderate to severe pain, particularly for neuropathic components 1.
- Physical therapy focusing on core strengthening and scar mobilization, beginning as soon as medically cleared, typically 4-6 weeks post-surgery.
- Complementary approaches including massage therapy, acupuncture, and TENS (Transcutaneous Electrical Nerve Stimulation) units for additional relief.
Considerations
The pain often results from nerve damage during surgery, abdominal wall weakness, or myofascial issues. If pain persists despite these interventions, consultation with a pain specialist may be necessary to explore nerve blocks, trigger point injections, or other specialized treatments. The most recent study in 2025 highlights the significant role gabapentinoids play in chronic pain treatment, with gabapentin being prescribed more frequently than pregabalin 1. However, careful patient monitoring and individualized treatment approaches are crucial due to notable side effects associated with these medications.
Prioritization
Given the most recent and highest quality study available 1, the management of chronic pain after a TRAM flap procedure should prioritize a multimodal approach, with a focus on gabapentin or pregabalin for neuropathic components, while considering the importance of monitoring and individualized treatment to minimize side effects and maximize quality of life.