Sometimes long after surgical wounds have healed, the scars remain painful due to sensitized nerve endings in the scars. While visually obvious, painful scar can be surprisingly hard to diagnose, because the pain is perceived to be coming from another “referred” location.
Scar Pain Referral Patterns
- Midline Neck scar refers to the neck & head, often triggering TMJ disorder
- Wrist scar after carpal tunnel surgery refers to the forearm mimicking tennis elbow.
- Midline low back scar refers to the back & buttock, mimicking spine arthritis. It can refer down the leg and mimic knee pain.
Treatments for Scar Pain
The most important aspect of scar pain treatment is recognition. Because of the pain referral patterns, often patients with painful scars end up chasing other differential diagnoses.
On examination it is important to manually push on the scar to assess its sensitivity. More often than not patients report that it is surprisingly tender. Sometimes the movement can trigger referred pain.
A diagnostic injection with local anesthetics is performed to prove the contribution of the scar to pain.
Treatments with steroid injection, Botox injection, and radiofrequency ablation can provide improvements that stack when repeated, possibly leading to an effective cure. Occasionally a surgical scar revision is necessary and an effective treatment.