Most patients experience pain after a surgical procedure, which is completely normal. This pain is called acute postoperative pain, should be of short duration, and is managed by the treating physician after surgery with appropriate medications.
Although pain immediately after surgery can usually be controlled relatively easily with simple analgesics, local anesthetics, or opioids, pain that persists after surgical wounds heal and discomfort that lasts more than 3 to 6 months—or even several years—after surgery is called chronic postoperative pain. Chronic postoperative pain is an important and increasingly recognized medical problem.
Injury to peripheral nerves during surgery can lead to persistent and resistant neuropathic pain, significantly affecting the patient’s quality of life.
The diagnosis of chronic postoperative pain is made by an experienced physician based on symptoms. This pain occurs not only in the area of the injured nerve but can also radiate to areas that were not directly affected.
It is described as sharp, piercing pain or burning and is characterized by paresthesia (non-painful, provoked or spontaneous numbness), dysesthesia (unpleasant, provoked or spontaneous numbness), and hyperpathia (painful response to repeated stimuli), following the distribution of a peripheral nerve or spinal root.
It may also be accompanied by allodynia, meaning pain caused by normally non-painful stimuli, motor dysfunction, loss of reflexes, limb swelling, and changes in skin temperature and color.
Diagnostic tools such as electromyography (EMG) or nerve block tests can assist in confirming postoperative neuropathy.
Treatment depends on the type of surgery and the patient’s medical history.
First-line recommended therapies include tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), and selective α2δ calcium channel inhibitors such as gabapentin and pregabalin.
Opioids, particularly tramadol, are considered second-line medications for postoperative pain. Topical application of lidocaine and capsaicin is indicated for the treatment of localized post-traumatic and postoperative pain, showing significant results.
Non-ablative pulsed radiofrequency or neuromodulation of peripheral nerves or the spinal cord can be alternative approaches in cases of severe pain or when side effects prevent continued use of medications.
Pulsed radiofrequency is a therapeutic method widely used in chronic pain management, offering the advantage of controlling pain without destroying tissue.
It has been successfully applied in patients with persistent neuropathic pain resistant to pharmacological therapy, such as pain following intercostal nerve injuries, thoracic surgeries, or mastectomies.
Transcutaneous magnetic stimulation, a non-invasive therapy applied over 6–8 weeks, or peripheral nerve stimulation via implanted neurostimulators, is also recommended and effective for controlling severe postoperative or post-traumatic pain.
