Home › Conditions › Persistent post-surgical pain

Persistent post-surgical pain

Persistent post-surgical pain is pain that continues for more than three months after an operation, beyond expected healing. It affects a meaningful minority of people after many common operations, most often involves injured or irritated nerves, and is assessable and treatable.

Surgery is expected to hurt, and then to stop hurting. For a meaningful minority of people it does not — the wound heals, the surgeon is satisfied, and yet months later pain persists at or near the operative site. This is a recognised condition with its own name, mechanisms and treatments. It is not a sign the operation failed, and it is not something that simply must be lived with.

Which operations does it follow? It can follow almost any procedure, but is most clearly documented after hernia repair, chest surgery, breast surgery including mastectomy, joint replacement, spinal surgery, caesarean section and amputation. The common thread is not the operation's size — persistent pain can follow minor procedures — but usually the involvement of nerves in or near the surgical field.

Why does it happen? The most common mechanism is injury or irritation of a nerve: cut, stretched, caught in a suture or clip, or enclosed in scar tissue. A divided nerve can form a neuroma — a sensitive bundle of regrowing fibres that fires pain signals at the lightest touch. In some people the nervous system's processing itself becomes sensitised, amplifying signals from an area that has structurally healed. Occasionally the pain has a separate cause — recurrence of the original problem, hardware irritation, or a new problem masquerading as surgical pain — which is why assessment starts from scratch rather than assuming.

How is it assessed? The pattern tells a story: pain with nerve-like qualities — burning, electric, triggered by light touch — in a defined territory suggests a specific nerve, and examination maps it. Ultrasound can often see a neuroma directly. The decisive step is frequently a diagnostic nerve block: if numbing one nerve abolishes the pain, the generator is found. If it does not, that result redirects the search — equally useful, and it spares you treatments aimed at the wrong target.

What can be done? Where a nerve or neuroma is confirmed: targeted injections, radiofrequency treatment, or surgical referral in selected cases. Where sensitisation dominates: medication matched to nerve pain mechanisms, graded rehabilitation, and desensitisation approaches. Most people need a combination, and a plan that also rebuilds the activity, sleep and confidence that months of unexplained pain erode.

When should I be referred? Earlier than most people are. Once pain has clearly outlived normal healing — around the three-month mark — assessment is worthwhile. Waiting longer rarely improves the starting position, and established pain is generally harder to unwind than newer pain.

Sources: International Association for the Study of Pain; Healthdirect Australia.