Scars occur as part of the body’s normal physiological response to a disruption in the integrity of any of its constituent tissues. Composed of connective tissue (fibrous and dense), scar tissue forms after injury or surgery.
The degree of scarring may be determined by the size, depth and location of the wound, as well as the patient’s age, heredity, skin characteristics and pigmentation. Scar tissue may appear to cause pain, but it is not the scar tissue itself that is painful.
Scar tissue has no nerve endings. It is the immobilization and attachment of fibrous adhesions to a nerve root that causes pain.
After some operations, such as inguinal hernia, lung, heart, kidney, and shoulder surgeries, as well as breast amputations, scar tissue pain is more common.
Symptoms
Patients with scar tissue pain often complain of neuropathic pain, during which there is continuous pain alternating with spontaneous attacks of shooting pain in the scar area. This pain can sometimes occur after a complaint-free period lasting a few months after surgery.
Diagnosis
During the exploration, squeezing a small part of the scar can be very painful. On the other hand, there may be more pain than expected with normal pain stimulation, such as pricking a needle in the scar area. Touching the skin lightly around the scar may also be experienced as painful.
Treatment
It is based on multidisciplinary treatment. Depending on the cause of your pain, your pain specialist will decide whether or not you should embark on physical treatment.
- Non-physical treatments
– Psychological treatment
– Rehabilitation - Physical Treatments
- Medication
– Oral medication for neuropathic pain: pregabalin, gabapentin, duloxetine, amitriptyline, tapentadol, oxycodone, tramadol.
– Topical medication: capsaicin cream, capsaicin 8% patch, lidocaine 5% dressing, iontophoresis. - Other treatments
– TENS (transcutaneous neurostimulation).
- Interventional pain treatments
– Local infiltration of the scar with anesthetics and corticoids.
– Pulsed radiofrequency on the scar.
– Pulsed radiofrequency on the nerve root.
Prevention
Although the literature on scarring is very extensive, very little is known about the mechanisms that regulate these processes, particularly those related to the development of pathologic scars. In recent years, the concept of scarring as a balance between cellular activity involved in scar formation and tissue remodeling has prevailed.
The study of the molecular mechanisms responsible for abnormal scarring is beginning to offer new therapeutic strategies to improve the functional and esthetic results of affected tissues. Currently, therapies aimed at reversing the molecular mechanisms of scar production are being studied, but are not yet commercially available.
Therefore, current treatments are empirical in nature and their efficacy is unpredictable and often doubtful. The existence of multiple treatments highlights the varied presentation of this entity that depends on multiple factors such as age, sex, race, location, and size of the scar and genetic predisposition, among others.