From the Guidelines
Post-operative scarring pain can be effectively managed with a multimodal approach, prioritizing non-opioid analgesics and minimizing opioid use whenever possible, as recommended by recent guidelines 1.
Recommended Treatment Approach
- Non-pharmacological interventions such as gentle massage of the scar tissue and application of silicone sheets or gel can improve scar pliability and reduce pain.
- Topical analgesics like lidocaine 5% patches or diclofenac 1% gel can be applied to the painful area for localized pain relief.
- Oral medications including acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) can be used for breakthrough pain, as they are recommended in multimodal analgesia 1.
- For persistent pain, gabapentin (starting at 300mg daily and gradually increasing) or amitriptyline (10-25mg at bedtime) may be beneficial as they target neuropathic pain often associated with scarring.
- Opioids, such as morphine, fentanyl, or sufentanil, should be reserved for moderate-to-severe pain unresponsive to other treatments, and their use should be optimized with patient-controlled analgesia (PCA) whenever possible, as suggested by guidelines 1.
Key Considerations
- Multimodal pain management should always be considered to improve analgesia while reducing individual class-related side effects 1.
- The use of opioids should be reduced as much as possible in postoperative pain management strategies, due to their potential for side effects and dependency 1.
- Regular assessment of sedation levels, respiratory status, and possible development of adverse events is crucial in patients receiving systemic treatment with opioids 1.
From the FDA Drug Label
Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. Unless treating hands, wash hands thoroughly with soap and water immediately after application. For best results, apply 3 to 4 times daily. Children under 18 years: ask a doctor
The answer to post-op scarring pain treatment is topical capsaicin.
- Apply a thin film of capsaicin cream to the affected area 3 to 4 times daily.
- Post-operative scarring pain may be managed with this treatment, but it is essential to follow the application instructions carefully 2.
From the Research
Post-Operative Scarring Pain Treatment
- The management of post-operative scarring pain should be tailored to each patient, taking into account their individual treatment expectations and the time course of prescriptions 3.
- First-line treatment options for acute mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), with topical NSAIDs recommended for non-low back, musculoskeletal injuries 3.
- For patients with acute musculoskeletal pain refractory to ibuprofen, oxycodone/acetaminophen may result in slightly greater pain relief than acetaminophen alone, but with more medication-related adverse events 4.
- Topical analgesics, such as topical NSAIDs, capsaicin, and lidocaine, are a non-opioid option for the treatment of chronic pain conditions, including neuropathic pain, musculoskeletal pain, and osteoarthritis 5.
- A fixed-dose combination of ibuprofen and acetaminophen may be an effective alternative to opioids in the management of common pain types, with evidence suggesting it can provide pain relief similar to or better than opioid and nonopioid comparators, while reducing the need for rescue opioid medication 6.
Treatment Options
- Acetaminophen: well tolerated, but lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 3.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): effective, but should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 3.
- Topical NSAIDs: recommended for non-low back, musculoskeletal injuries 3.
- Oxycodone/acetaminophen: may result in slightly greater pain relief than acetaminophen alone for patients with acute musculoskeletal pain refractory to ibuprofen, but with more medication-related adverse events 4.
- Ibuprofen/acetaminophen fixed-dose combination: may be an effective alternative to opioids in the management of common pain types, with fewer adverse events 6.