Scar tissue is painless

Deep local anesthesia helps with scar pain

Scars from operations can suddenly cause severe pain long after the procedure. If there is no effective treatment in good time, a chronic pain syndrome can easily develop. What needs to be done here, explains Dr. Thomas Flöter from the Pain Center Frankfurt am Main in today's pain casuistic episode.

A 43-year-old employee comes to our practice for pain therapy because of increasingly unbearable permanent pain in the left thigh and knee with radiation in both the lower leg and the back up to the head. The pain is described as sharp and sometimes dull.

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The therapy of choice here is therapeutic local anesthesia of the hyperalgesic zones of the scar. These areas must be anesthetized deep down to the periosteum with a fine needle. Because a diffuse injection or extensive infiltration, as has been done with this patient so far, has only an inadequate effect.

The physical examination - muscles and trigger points - also shows that the back pain, which radiates up to the head, is secondary to poor posture (relieving the leg). Therefore, intensive physiotherapy is prescribed in parallel.

For long-term pain relief and so that the physiotherapeutic measures are painless, a slow-release opioid of WHO level 2 (Valoron®® N retard) is prescribed, since treatment with non-steroidal anti-inflammatory drugs is not tolerated due to chronic gastritis.

Treatment with an opioid is also indicated for the patient in order to be able to counteract the chronic pain process more intensively. The dosage is 100 mg of the preparation every eight hours. With this therapy, the patient can walk without a stick again after just three weeks and sleep pain-free at night. The medication can then also be discontinued.



CONCLUSION

There are various theories as to how scar pain occurs, for example through short circuits between the incoming and outgoing nerve fibers, which can lead to a build-up of impulses in the nerve itself. To relieve scar pain, deep local anesthesia of the hyperalgesic zone and possibly the use of slow-release opioids of WHO level 2 is recommended.

The earlier the therapy is started, the lower the risk that a pain memory will develop, which then makes the therapy more difficult. It is therefore not a matter of course that the treatment started so quickly in this patient, although the complaints had existed for several years.