The body’s response to a surgical incision or internal trauma is the formation of scar tissue, a necessary healing process where specialized cells replace damaged tissue with fibrous material, primarily collagen. This reparative tissue differs from the original, healthy tissue because its fibers are laid down in a dense, less organized pattern. This material can cause chronic pain, which often begins manifesting long after the initial surgical recovery period is complete.
How Scar Tissue Causes Chronic Pain
The dense, disorganized nature of the collagen fibers within scar tissue is the primary structural reason for persistent pain. Unlike the surrounding pliable tissue, scar tissue lacks elasticity and flexibility, creating points of mechanical tension within the body. This stiffness can restrict the natural movement of muscles, fascia, and joints, leading to a constant, low-grade discomfort or pain that intensifies with movement or stretching.
One of the most specific mechanisms of chronic pain involves the relationship between the scar and peripheral nerves. As the fibrous tissue forms and matures, it can physically compress, or “entrap,” nearby nerves, leading to neuropathic pain. This nerve entrapment often causes symptoms described as burning, tingling, shooting sensations, or hypersensitivity to touch in the area surrounding the scar.
The scar matrix can also harbor a persistent, low-grade inflammatory state, which contributes to ongoing pain. Even after the acute healing phase, signaling molecules within the dense collagen structure can continue to activate pain receptors. This chronic irritation maintains a pain pathway, making the area sensitive even without direct pressure or movement.
Identifying Different Types of Problematic Scars
Painful scarring can manifest in two major categories: visible external scars and hidden internal scars. External scars that become problematic often involve an overproduction of collagen, resulting in raised and thickened tissue. Hypertrophic scars are raised, red, and firm, but they remain confined to the original boundary of the surgical incision and may soften over time.
Keloids represent a more aggressive form of external scarring where the dense fibrous tissue grows beyond the edges of the original wound. Both hypertrophic scars and keloids can be sources of pain and intense itching due to the volume of tissue and the tension placed on the surrounding skin.
Internal scars, known as adhesions, are a frequent source of deep, chronic pain, especially following abdominal or pelvic surgery. Adhesions are fibrous bands that form between internal organs or tissues that are not normally connected. When a person moves, these inelastic bands pull on the bound structures, causing deep, visceral pain. Adhesions are not visible externally and can cause functional issues, such as partial bowel obstruction, which may lead to referred pain in areas like the lower back or pelvis.
Treatment and Management Strategies
Addressing scar-related pain often begins with non-invasive and manual techniques designed to restore tissue pliability. Physical and manual therapy, including specialized scar massage and myofascial release, is used to gently mobilize the scar tissue and break up the dense collagen bonds. These techniques aim to improve the elasticity and glide of the scar relative to the underlying structures, reducing tension and restriction.
For localized neuropathic pain, medical interventions like nerve blocks or corticosteroid injections may be utilized. Corticosteroids can be injected directly into a raised or inflamed scar to reduce inflammation and decrease the bulk of the tissue. Nerve blocks involve injecting an anesthetic near the irritated nerve to temporarily interrupt the pain signals, providing relief and helping identify the specific source of the discomfort.
When conservative methods fail, especially for severe adhesions or nerve entrapment, surgical revision may be considered. Surgical release of internal adhesions, known as adhesiolysis, is performed to cut the fibrous bands that are tethering organs together. For external scars, a surgeon may perform a nerve decompression procedure to free a trapped nerve from the surrounding scar tissue.