What causes pain from scar tissue (adhesions)?

From the Guidelines

Scar tissue pain management should prioritize a multimodal therapeutic strategy, including regional analgesia and anti-hyperalgesic drugs, especially for patients undergoing high-risk surgical procedures such as thoracotomy, breast surgery, sternotomy, and iliac crest sampling 1. When managing scar tissue pain, it's essential to consider the surgical factors that contribute to the development of chronic post-surgical pain (CPSP). These factors include:

• Surgical procedures that are more likely to cause CPSP, such as thoracotomy, breast surgery, sternotomy, and iliac crest sampling
• Repeated surgical procedures, which can increase the risk of CPSP due to the high number of nerve damages on a revised scar tissue and more inflammatory tissues
• Surgical procedures with preoperative pain on the site of the intervention
• A duration of surgery greater than 3 hours For patients with scar tissue pain, a combination of treatments can be effective, including:
• Over-the-counter pain medications like ibuprofen or acetaminophen to reduce inflammation and discomfort
• Topical options such as silicone gel sheets or creams containing ingredients like vitamin E or onion extract
• Physical therapy techniques like massage to break down adhesions and improve flexibility It's crucial to identify patients who are at high risk of developing CPSP and provide them with cautious supervision and a tailored treatment plan, as recommended by the expert panel's guidelines on postoperative pain management 1.

From the Research

Scar Tissue Pain Management

• Scar tissue pain can be a significant issue for individuals, especially those who have experienced burn injuries or surgery 2
• The management of scar tissue pain involves a range of conservative treatment interventions, including edema management, pressure therapy, gels or gel sheets, combined pressure therapy and gels, serial casting, scar massage, and passive stretching 3
• Topical therapies, such as capsaicin and topical diclofenac, have been shown to be effective in the treatment of chronic pain, including scar tissue pain 4, 5
• The use of topical NSAIDs, high concentration topical capsaicin, and topical lidocaine has been supported by evidence for various painful conditions, including neuropathic pain, musculoskeletal pain, and osteoarthritis 4, 5

Treatment Options

• Compression for edema reduction should be initiated 48-72 hours post-injury and continued for wounds that require longer than 21 days to heal until scar maturation 3
• Custom fabricated pressure garments should be applied once the edema is stabilized and adequate healing has occurred, with a wearing time of more than 16 hours per day 3
• Gels for post-burn scar management should extend beyond the scar, and serial casting should be applied when contractures interfere with function 3
• Forceful scar massage should be avoided early in the wound healing process or when the scar is inflamed or breaks down 3

Conservative Treatments

• Conservative treatments, including pharmacological therapy, procedures, and exercise, are commonly used to control chronic pain 6
• Medications such as anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and antidepressants may be used to manage chronic pain 6
• Procedures such as injection of steroids and local anesthetics, pulsed radiofrequency (PRF), repetitive transcranial magnetic stimulation (rTMS), and prolotherapy may also be used 6