Scar tissue from surgery can be a source of chronic pain. This fibrous connective tissue is the body’s natural method of healing, replacing specialized tissue with a dense, disorganized collection of collagen fibers following an injury or incision. While this process is necessary to repair the damaged area, the resulting scar can sometimes become a long-term source of discomfort.
Pain associated with scars is a common post-surgical issue that can affect mobility and quality of life. The discomfort can range from mild tenderness to intense, chronic sensations, depending on the underlying biological changes that occur during the healing period.
Biological Causes of Pain
The transition from a healing wound to a painful scar is often rooted in how the new tissue interacts with surrounding structures beneath the skin. One of the most common biological mechanisms is the entrapment or impingement of sensory nerves. As scar tissue forms and contracts, it can physically compress small cutaneous nerves, leading to neuropathic pain.
This nerve compression can produce distinct symptoms, such as a burning, tingling, or shooting sensation that may radiate beyond the immediate scar site. The disorganized collagen fibers of the scar also lack the elasticity of the original tissue, which creates chronic tension in the surrounding fascial layers and muscles. This lack of flexibility can cause a deep, aching discomfort, especially when the body moves or attempts to stretch the area.
A significant internal cause of pain is the formation of adhesions, which are internal bands of scar tissue that incorrectly connect body surfaces, such as organs, muscles, or fascia. These adhesions bind structures together that should glide independently, causing a restrictive, pulling sensation. When a person moves, the adhered tissues are stretched, leading to tightness, restricted range of motion, and chronic pain that often increases with activity. Additionally, some painful scars maintain a state of low-grade, persistent inflammation, where the body’s immune response continues to irritate the dense fibrous tissue, contributing to ongoing tenderness and hypersensitivity.
Physical Manifestations of Painful Scars
The external characteristics of a scar often indicate the underlying cause of the pain. A common painful manifestation is the hypertrophic scar, which appears as a raised, red, and thickened area that remains strictly within the boundaries of the original surgical incision. These scars can be tender or painful due to the excessive collagen deposited, which increases tension and limits the flexibility of the local skin.
A more aggressive form is the keloid scar, characterized by tissue that grows beyond the borders of the initial wound, often appearing rubbery and hard. Keloids are frequently associated with intense symptoms, including persistent itchiness, a burning sensation, and pain, as the excessive collagen mass exerts pressure on surrounding nerve endings. Both hypertrophic and keloid scars can also contract over joints, leading to pain by restricting the normal range of motion.
In contrast, atrophic scars are depressed or sunken, resulting from a loss of underlying tissue during the healing process. While the scar itself may not be the primary source of pain, the structural defect and the tissue damage beneath it can still lead to neuropathic issues if nerves are involved in the deeper layers.
Strategies for Managing Scar Pain
Managing chronic scar pain requires a multidisciplinary approach focused on restoring tissue pliability and addressing neurological signals. Physical and manual therapies are often the first line of treatment, involving hands-on techniques designed to reorganize the collagen fibers. Scar massage, which includes cross-friction and deep tissue techniques, helps to break down existing adhesions and improve the mobility of the scar relative to the underlying muscle and fascia.
Therapists also employ specialized methods like myofascial release and instrument-assisted soft tissue mobilization to target deeper restrictions and promote healthy tissue remodeling. Stretching and mobilization exercises are crucial for maintaining and improving the range of motion, which prevents the scar from restricting movement and generating tension pain. Early intervention with these techniques can significantly reduce the potential for long-term functional impairment.
For pain that originates from nerve involvement, medical interventions can provide targeted relief. Corticosteroid injections are administered directly into the scar tissue to reduce inflammation and decrease the bulk of hypertrophic or keloid scars. For localized neuropathic pain, specialists may use nerve blocks or trigger point injections with local anesthetics to temporarily quiet the pain signals originating from the compressed nerves.
In severe cases, surgical revision may be considered, particularly when the pain is due to nerve entrapment or dense, restrictive adhesions. This procedure involves carefully excising the painful scar tissue and re-closing the wound to minimize the risk of recurrence. Consulting with a specialist, such as a physical therapist, pain management specialist, or plastic surgeon, is necessary for a proper diagnosis and the development of a comprehensive treatment plan.