What is Post Surgical Persistent Pain

Post Surgical Persistent Pain (PSPP) refers to chronic pain that persists or develops after a surgical procedure. It is a condition where pain continues beyond the normal healing period and can significantly impact a person's quality of life and recovery.

Types of Post Surgical Persistent Pain

There are various types of PSPP that can occur after different surgical procedures, including

• Incisional Pain: Pain that originates from the surgical incision site, which may be caused by nerve damage, tissue inflammation, or poor wound healing.

• Neuropathic Pain: Pain resulting from nerve damage during surgery, leading to altered nerve function and chronic pain.

• Visceral Pain: Pain arising from damage or inflammation in internal organs caused by the surgical procedure.

• Phantom Limb Pain: Pain experienced in a limb that has been amputated, which can persist or develop after the surgical removal.

• Chronic Regional Pain Syndrome (CRPS): A rare but severe condition characterized by chronic pain, swelling, and changes in skin temperature and appearance. It can develop after surgery, particularly in limbs.

Causes and Common Conditions of Post Surgical Persistent Pain

The causes and conditions contributing to PSPP can vary, and some common factors include

• Nerve Damage: Injury to peripheral nerves during surgery, leading to neuropathic pain.

• Surgical Trauma: Tissue trauma or inflammation caused by the surgical procedure itself.

• Infection: Postoperative infections can cause ongoing pain and delayed healing.

• Scar Tissue Formation: Excessive scar tissue formation around surgical sites can lead to chronic pain.

• Psychological Factors: Emotional stress, anxiety, or depression can amplify the perception of pain after surgery.

Symptoms of Post Surgical Persistent Pain

• Chronic pain that persists beyond the expected healing time.
• Aching, burning, or shooting pain at or near the surgical site.
• Increased sensitivity to touch or pressure.
• Limited range of motion or functional impairment.
• Sleep disturbances and fatigue.
• Emotional distress, such as anxiety or depression, is related to persistent pain.

Diagnosis of Post Surgical Persistent Pain

Diagnosing PSPP involves a comprehensive evaluation, which may include

• Medical History:Detailed discussion about the surgical procedure, pain characteristics, and previous treatments.

• Physical Examination: Assessing the surgical site, checking for signs of inflammation, and evaluating nerve function.

• Imaging:X-rays, MRI scans, or other imaging tests may be conducted to assess surgical outcomes and identify any potential causes of persistent pain.

• Nerve Studies: Electromyography (EMG) or nerve conduction studies (NCS) may be performed to assess nerve function and identify potential nerve damage.

How do you know if Post Surgical Persistent Pain is serious

Determining the severity of PSPP requires professional evaluation. However, certain signs may indicate a more serious condition, including

• Intense, unrelenting pain that significantly affects daily activities and quality of life.
• Progressive worsening of pain over time.
• Neurological symptoms include numbness, paralysis, and bladder or bowel control loss.
• Signs of infection, such as fever, increased redness, or drainage from the surgical site.
• Unexpected or prolonged recovery period compared to the expected healing time.

Interventional Pain Management of Post Surgical Persistent Pain

Interventional pain management techniques can be valuable in the treatment of PSPP. Some commonly used interventions include

• Nerve Blocks: Injecting local anesthetics or medications near affected nerves to provide pain relief.

• Spinal Cord Stimulation: Implanting a device that sends electrical impulses to the spinal cord, blocking pain signals, is called spinal cord stimulation.

• Radiofrequency Ablation: Using heat generated by radiofrequency energy to selectively destroy nerves responsible for transmitting pain signals.

• Epidural Steroid Injections: Administering corticosteroids into the epidural space to reduce inflammation and alleviate pain.

• Trigger Point Injections: Injecting medications into trigger points or tight knots in muscles to relieve pain and promote relaxation.