Persistent Post-Surgical Pain (PPSP) Solutions

Defining Persistent Post-Surgical Pain

Post-surgical pain is pain that occurs after a surgical procedure. It is a normal part of the healing process, but its intensity and duration can vary widely depending on the type of surgery, the individual’s pain threshold, and other factors. Post-surgical pain can be acute (short-term) or become chronic (long-lasting) if it persists beyond the expected healing period.

The definition of Chronic/Persistent Post Surgical or Post Trauma Pain was standardised in 2019, after the inclusion in the new International Classification of Diseases, Eleventh Revision (ICD-11).

• Pain develops or increases in intensity after a surgical procedure or tissue injury
• Pain persists beyond the healing process, that is, more than equal to 3 months after the triggering event
• Localisation: either at the surgical area/ injury area, or projected onto the innervation area of a nerve in this area, or related to a dermatome or Head’s zone (after surgery to a deep somatic or visceral tissue)
• Other causes of pain ie, pre-existing pain conditions, infection, malignancy are excluded
• Chronic post surgical pain can often show characteristics of neuropathic pain (35-57%)
• It is distinguished between tissue trauma arising from a controlled procedure in the delivery of healthcare (surgery) and forms of uncontrolled accidental damage (other traumas)

What Causes Persistent Post-Surgical Pain?

Pain that persists for a significant time following a surgery can stem from multiple causes, including:

• Tissue Injury. Surgery often involves cutting, pulling, or manipulating tissues, which can cause pain.
• Inflammation. The body’s inflammatory response to surgery can cause swelling and pain.
• Nerve Damage. Surgical procedures can inadvertently damage nerves, leading to pain.
• Infection: Post-operative infections can cause significant pain and discomfort.
• Scar Tissue Formation. The development of scar tissue around surgical sites can cause pain.

It is also important to understand that there are different types of post-surgical pain, acute pain and chronic pain.

Acute post-surgical pain typically lasts a few days to a few weeks and gradually decreases as the body heals.

On the other hand, chronic or persistent post-surgical pain persists for months or even longer after surgery and may require specialised pain management strategies. This type of pain is often neuropathic in nature ie, it occurs due to the dysfunction in the neurological system. 

Operations that can lead to persistent post surgery pain include 

• Sternotomy (cardiac surgery)
• Mastectomy
• Thoracotomy
• Inguinal Hernia repair
• Large joint repair (such as knees or hips) or replacement
• Abdominal surgery
• Caesarean Section
• Amputation

The incidence is highest after procedures such as amputation, mastectomy and thoracotomy.

What Are the Risk Factors for Persistent Post Surgery Pain?

There are several factors that increase the risk of Persistent Post Surgery Pain. These include:

1. Surgical or Treatment Factors
   • Prolonged duration of surgery
   • Extent of tissue damage caused
   • Location of tissue damage/ Type of tissue injured
   • Post Operative complications such as bleeding, infection
   • Revision surgery or repeat surgery
   • Radiotherapy
   • Chemotherapy
2. Patient Factors
   • Long term opioid use
   • Psychosocial risk factors: anxiety, catastrophising, depression, hypervigilance, low self-efficacy
   • Young age
   • Female 
   • High BMI
3. Preoperative Chronic Pain
   • Pre-existing chronic painful conditions – migraines, fibromyalgia
   • Long duration of pre-existing chronic pain
4. Post Operative Pain
   • High intensity of postoperative acute pain
   • Post operative visceral pain
   • Post operative neuropathic type pain

What is a Persistent Pain Management Doctor?

There are multiple reasons why someone might choose to see a pain specialist for persistent post-surgical pain.

• Expertise. Pain specialists, such as orthopaedic surgeons, neurosurgeons, rehabilitation physicians, or pain management specialists, have specific training and expertise in diagnosing and treating chronic pain issues. They are familiar with various conditions that cause post-surgical pain and can offer specialised treatment options.
• Accurate Diagnoses. Persistent post-surgical pain can result from a variety of underlying conditions or an issue or complication that occurred during the surgery itself, or a combination of factors. A pain specialist can conduct a thorough evaluation, which may include imaging studies like X-rays, MRIs, or CT scans, to accurately diagnose the source of the pain.
• Personalised Treatment Plans. Once the cause of the pain is identified, a specialist can develop a personalised treatment plan tailored to your individual needs. This plan may include a combination of therapies such as physical therapy, medications, injections, minimally invasive procedures, or surgery if necessary.
• Pain Management Therapies and Techniques. Chronic or persistent post-surgical pain can significantly impact your entire life, affecting your ability to work, perform daily activities, and enjoy leisure time. Pain specialists can offer various pain management techniques to help alleviate discomfort and improve function, including medication management, nerve blocks, spinal cord stimulation, or other interventional procedures.
• Prevention and Education. Pain specialists can provide education and guidance on lifestyle modifications, ergonomic principles, exercises, and preventive measures to reduce the risk of future problems or exacerbations of existing conditions.
• Coordinated Care. In cases where post-surgical pain is complex or involves multiple medical specialties, a pain specialist can coordinate care with other healthcare providers, such as physiotherapists, chiropractors, psychologists, or pain psychologists, to ensure comprehensive management of the condition.

Overall, seeking care from a pain specialist can offer patients with persistent post-surgical pain access to specialised expertise, an accurate diagnosis, personalised treatment, and comprehensive management strategies to improve their overall health.

Multidisciplinary Healthcare Teams for Post-Surgical Pain Management 

Several types of healthcare professionals are involved in the diagnosis, treatment, and management of post-surgical pain. These include:

• General Practitioners: General practitioners play a crucial role in coordinating care for individuals with chronic pain. They may initially evaluate the patient, provide treatment, and make referrals to pain specialists or other specialists as needed.

• Pain Management Specialists: Pain management specialists focus on the evaluation and treatment of chronic pain conditions, including post-surgical pain. They may use a multidisciplinary approach that includes medications, injections, physical therapy, and psychological interventions to address pain and restore general comfort.
• Physical Therapists. Physiotherapists are experts in rehabilitative exercises and techniques to improve mobility, strength, and flexibility. They develop individualised treatment plans to address various types of pain and may incorporate modalities such as ultrasound, electrical stimulation, dry needling and taping.
• Occupational Therapists. Occupational therapists focus on helping their clients perform daily activities despite physical limitations or disabilities. They may provide ergonomic assessments, assistive devices, and adaptive strategies to manage persistent pain and prevent further injury.
• Psychologists and Counsellors. Psychologists and counsellors can help you cope with the emotional and psychological aspects of living with persistent pain. They may use techniques such as cognitive-behavioural therapy, relaxation training, and stress management to improve coping skills and overall well-being.

Collaboration among these healthcare professionals is often necessary to provide comprehensive care for patients with post-surgical pain, addressing both the physical and psychosocial aspects of the condition.

How Does a Pain Specialist Treat Persistent Post-Surgical Pain?

A pain specialist employs a variety of approaches to treat post-surgical pain, depending on the underlying cause, severity, and individual patient factors. 

Here are some common methods used by pain specialists to manage chronic post-surgical pain:

1. Medication Management. Pain specialists may prescribe medications to alleviate pain, reduce inflammation, and improve function. Commonly prescribed medications include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, opioids (for short-term use only in severe cases), antidepressants, and anticonvulsants.
2. Physical Therapy. Physical therapy plays a crucial role in the management of any type of chronic or persistent pain. A physical therapist will design an individualised exercise program to improve strength, flexibility, and posture, as well as provide manual therapy techniques to reduce pain and improve mobility.
3. Interventional Procedures. Pain doctors may perform various interventional procedures to alleviate pain and improve function. These may include epidural steroid injections, facet joint injections, nerve blocks, radiofrequency ablation, spinal cord stimulation and peripheral field/ peripheral nerve stimulation.
4. Lifestyle Changes. Managing persistent post-surgical pain may include recommendations for maintaining a healthy weight, adopting ergonomic principles in daily activities, improving posture, quitting smoking (if applicable), and incorporating stress management techniques.
5. Psychological Treatment. Seeing a psychologist or counsellor to provide psychological support and interventions such as cognitive-behavioural therapy can help cope with pain, stress, and anxiety.

By employing a multidisciplinary approach that addresses the physical, psychological, and social aspects of persistent pain, Dr. Mittal and her collaborative team of specialists can help patients effectively manage their symptoms, improve function, and enhance overall quality of life.

What Does a Treatment Plan for Post-Surgical Pain Involve?

A treatment plan for persistent post-surgical pain typically involves a comprehensive approach that addresses the underlying cause of the pain, alleviates symptoms, improves function, and prevents future episodes. 

Here are the key components of a treatment plan for post-surgical pain:

• Medical Evaluation. The first step in developing a treatment plan is a thorough medical evaluation, which may include a review of the surgery plan and follow-ups, your medical history, a physical examination, and diagnostic tests such as X-rays, MRI, or CT scans to determine the cause(s) of the pain.
• Pain Management. Pain management is a crucial aspect of the treatment plan and may involve various strategies, including medication management. Commonly prescribed medications for post-surgery pain include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, opioids (for short-term use in severe cases), antidepressants, and anticonvulsants.
• Physical Therapy. Physical therapy plays a key role in treating persistent post-surgical pain by improving strength, flexibility, posture, and mobility. A physiotherapist designs an individualised exercise program tailored to your needs, which may include stretching exercises, strengthening exercises, aerobic conditioning, and manual therapy techniques such as massage or spinal manipulation.
• Interventional Procedures. Depending on the cause and severity of the pain, interventional procedures may be recommended to alleviate symptoms and improve function. These procedures may include epidural steroid injections, facet joint injections, nerve blocks, radiofrequency ablation, spinal cord stimulation.
• Lifestyle Modifications. Positive changes to your routine can be essential for managing chronic pain and preventing future episodes. This may include maintaining a healthy weight, adopting ergonomic principles in daily activities, improving posture, quitting smoking (if applicable), and incorporating stress management techniques such as relaxation exercises or mindfulness meditation.
• Education and Self-Management Strategies. Patient education is a critical component of the treatment plan, empowering patients to actively participate in their care and make informed decisions about their health. Pain doctors provide information on the condition, treatment options, and strategies for self-management, including proper body mechanics, activity modification, and resources for further support and education.
• Psychological Support. Support may be provided by collaborating with psychologists or counsellors to address issues such as pain-related anxiety, depression, or stress through interventions such as cognitive-behavioural therapy or relaxation techniques.
• Follow-Up and Monitoring. Regular follow-up appointments with your team are essential to monitor the progress of the treatment plan, adjust medications or therapies as needed, and address any new or worsening symptoms. Patients are encouraged to communicate openly and report any changes in their condition or response to treatment.

By incorporating these components into a comprehensive treatment plan, Dr. Mittal can effectively manage post-surgical pain, improve function, and enhance the overall quality of life for patients.

The Challenges of Living with Persistent Post-Surgical Pain

Living with post-surgical pain presents numerous problems or issues that can significantly impact a person’s physical, emotional, and social well-being. 

Some of these challenges include:

• Persistent Discomfort. Chronic pain often leads to persistent discomfort, ranging from mild to severe, which can interfere with daily activities such as walking, sitting, standing, and sleeping. This constant pain can affect all parts of your life and make it difficult to concentrate or enjoy leisure activities.
• Limited Mobility. Persistent pain may restrict mobility and range of motion, making it challenging to perform tasks that require bending, lifting, or twisting. Reduced mobility can lead to dependency on others for assistance with activities of daily living and decrease independence, leading to social isolation, inability to work, or otherwise actively participate in one’s own life.
• Impact on Work and Productivity. Chronic pain can impair work performance and productivity, leading to missed workdays, decreased job satisfaction, and financial strain. Some individuals may need to modify their job duties, take extended leaves of absence, or even retire early due to their chronic pain following a surgery.
• Emotional Distress. Dealing with chronic pain can take a toll on one’s mental health, leading to feelings of frustration, anxiety, depression, and irritability. Coping with the emotional distress of persistent post-surgical pain may require support from mental health professionals and strategies for stress management.
• Sleep Disturbances. Chronic pain can disrupt sleep patterns, causing difficulty falling asleep, staying asleep, or achieving restful sleep. Poor sleep quality can exacerbate pain perception, worsen mood disturbances, and contribute to fatigue and daytime drowsiness.
• Social Isolation. Chronic post-surgical pain may limit social activities and participation in hobbies or recreational pursuits, leading to feelings of isolation and loneliness. Social support from family, friends, and support groups can help mitigate feelings of isolation and provide emotional encouragement.
• Impact on Relationships. Chronic pain can strain relationships with family members, friends, and romantic partners due to changes in mood, behaviour, and participation in activities. Effective communication, empathy, and support from loved ones are essential for maintaining healthy relationships.
• Financial Difficulties. Managing chronic pain often involves medical expenses, including doctor visits, diagnostic tests, medications, physical therapy, and sometimes surgery or other interventions. Additionally, indirect costs such as lost wages, transportation expenses, and home modifications to accommodate a chronic pain condition may be incurred.
• Fear of Re-injury. Fear of exacerbating existing pain or sustaining new injuries may cause you to avoid physical activities or movements, resulting in deconditioning, loss of muscle strength, weight gain and further functional impairment.
• Depression and Frustration. Persistent post-surgical pain can lead to feelings of frustration, hopelessness, and despair, especially if your surgery or other treatments are ineffective or symptoms worsen over time. It’s essential for chronic pain sufferers to maintain hope and continue working with healthcare providers to explore new treatment options and improve their quality of life.

Overcoming the challenges associated with persistent post-surgical pain requires a comprehensive approach that addresses both the physical and emotional aspects of the condition, along with support from healthcare providers, loved ones, and community resources.

How Do I Find a Post-Surgical Pain Specialist Near Me?

To find a pain specialist near you, you can start by discussing your post-surgical pain concerns with your surgeon and their team. They can evaluate your symptoms, provide initial treatment, and refer you to a pain management doctor following your surgery.

You can also seek recommendations from friends, family members, or colleagues who have experience with chronic pain treatment. They may be able to recommend a reputable specialist based on their own positive experiences.

Ask at the hospital or medical centre where you received your surgery and inquire about their spine, orthopaedic, neurosurgical or chronic pain departments. They may have dedicated rehabilitation centres or clinics staffed by pain specialists. These facilities often have multidisciplinary teams of experts and access to cutting-edge treatments and research.

During your search for a pain doctor near you, be sure to take into account less obvious factors such as the specialist’s location, office hours, and availability when choosing a pain specialist. Look for a pain doctor who assesses your symptoms, medical history, treatment preferences and has the correct qualifications and local experience in looking after your persistent pain.

Ultimately, trust your instincts and choose a pain specialist who listens to your concerns, communicates effectively, and offers confidence in their ability to provide high-quality care.

If you are in the Melbourne area, contact the Persistent Pain Solutions clinic to connect with Dr Mittal who can help diagnose and treat your condition effectively.

Persistent Pain Solutions for Post-Surgical Pain in Melbourne 

Dr. Meena Mittal and her collaborative team of healthcare professionals are deeply committed to providing compassionate care to every person who arrives at the Persistent Pain Solutions clinic seeking solutions for their post-surgical pain.

We understand the physical and emotional toll that chronic or long term pain can take on patients and their loved ones. That’s why we focus on offering empathy, understanding, and support in every interaction. 

From the moment you enter our doors, you’ll be met with a warm and welcoming environment where your pain and concerns are understood and your priorities are valued. 

Dr. Mittal takes the time to listen, engage, and evaluate your condition. Together, a personalised treatment plan tailored to your unique challenges is developed and instituted.

Compassion is fundamental to health and healing, and Dr Mittal is dedicated to guiding you on your journey to relief from post-surgical pain and improvement in your overall quality of life.