Post-Surgical Pain: Understanding and Treating Persistent Pain at Peninsula Pain Management
By Dr. James Forbes, Pain Management Specialist – Peninsula Pain Management, New South Wales, Australia
What is Post Surgical Pain?
As a physician, I often remind patients that surgery is both a treatment and a trauma. While surgical procedures are performed to correct disease, repair injury, or improve function, they inevitably involve cutting through skin, muscle, and nerves. For most patients, post-surgical pain is temporary, lasting days to weeks as tissues heal. But for a significant number of people, pain lingers far beyond the expected recovery window.
When pain lasts more than three months after surgery, we call it chronic post-surgical pain (CPSP). This is not rare—research suggests that up to 20–30% of surgical patients develop long-lasting pain, depending on the procedure. For some, the pain becomes more disabling than the original condition that required surgery.
At Peninsula Pain Management, we specialize in diagnosing and treating persistent surgical pain. Our mission is to help patients recover not just from their operation, but from the long shadow of pain that sometimes follows it.
Why Does Post-Surgical Pain Occur?
Not all post-surgical pain is the same. Some pain is expected, part of the normal healing process. But when pain persists, there are usually multiple contributing factors:
- Nerve Injury
Many surgeries—such as hernia repair, mastectomy, knee replacement, or spinal surgery—involve cutting near or through nerves. Damaged nerves can misfire, producing neuropathic pain (burning, stabbing, tingling). - Scar Tissue and Adhesions
Scar formation is normal after surgery, but sometimes scar tissue entraps nerves or restricts joint and muscle movement, leading to chronic surgical site pain. - Inflammation and Hypersensitivity
Ongoing inflammation can sensitize nerve endings, making the surgical area abnormally painful. This can develop into central sensitization, where the brain and spinal cord amplify pain signals. - Psychological Stress and Anxiety
Fear, depression, or trauma surrounding the surgical experience can worsen pain perception, prolong recovery, and limit mobility. - Complications
Infections, hardware issues, or improper healing can all contribute to persistent pain.
The end result is a condition that is more than “just surgical soreness”—it is often a mix of neuropathic, inflammatory, and musculoskeletal pain that requires specialized treatment.
Common Surgeries Associated with Chronic Pain
While any surgery can lead to post-operative pain, some procedures carry a higher risk:
- Mastectomy and breast surgery – nerve injury and scar-related pain
- Knee replacement (TKA) – stiffness, nerve pain, and mechanical irritation
- Hip replacement – groin or thigh pain from nerve or tendon irritation
- Spinal surgery – failed back surgery syndrome (FBSS), persistent sciatica
- Hernia repair – groin nerve entrapment causing burning or stabbing pain
- Thoracic surgery – chronic chest wall pain from rib spreading or nerve injury
- Amputation – phantom limb pain and residual limb pain
Patients may describe their pain as sharp, burning, aching, throbbing, or tingling. For some, the pain is constant; for others, it flares with movement, weather changes, or even light touch to the surgical scar.
Why Standard Pain Medications Aren’t Enough
Most post-operative patients are prescribed opioids or anti-inflammatory drugs during their initial recovery. While these may help in the short term, they are rarely effective for chronic post-surgical pain.
- Opioids can lead to dependency, tolerance, and side effects without resolving the underlying pain mechanism.
- NSAIDs may help inflammation but have limited effect on nerve-related pain.
- Acetaminophen is generally safe but insufficient for severe nerve pain.
This is why patients with persistent surgical pain need care from a pain management specialist who understands the unique biology of chronic post-surgical pain.
How Peninsula Pain Management Helps Patients with Post-Surgical Pain
Comprehensive Evaluation
We begin with a detailed consultation, including:
- Surgical history and review of operative notes
- Imaging studies (X-rays, MRI, CT) when appropriate
- Neurological exam for nerve injury or neuropathy
- Pain mapping to identify specific triggers
This allows us to determine whether pain is neuropathic, musculoskeletal, inflammatory, or a combination.
Interventional Pain Procedures
When medications are not enough, we offer targeted pain management procedures, including:
- Nerve blocks for diagnostic and therapeutic relief (e.g., ilioinguinal nerve block for post-hernia pain)
- Trigger point injections for scar or muscle-related pain
- Radiofrequency ablation (RFA) to deactivate overactive pain nerves
- Spinal cord stimulation (SCS) for failed back surgery syndrome or widespread nerve pain
- Peripheral nerve stimulation for localized surgical site pain
These interventional therapies can provide lasting relief when conventional medications fail.
Long-Term Partnership
Chronic pain management is a journey. At Peninsula Pain Management, we see ourselves as partners in our patients’ recovery—adjusting treatments, providing reassurance, and working together for long-term relief.
Why Patients Trust Peninsula Pain Management
- Led by Dr. James Forbes, board-certified in pain medicine
- Based in New South Wales, proudly serving the Central Coast
- A reputation for personalised, evidence-based care
- A multidisciplinary approach that puts patient outcomes first
Medication Management
We prescribe medications tailored to the patient’s pain type, including:
- Neuropathic agents such as gabapentin, pregabalin, or duloxetine
- Topical treatments (lidocaine patches, capsaicin cream) for scar or incision pain
- Anti-inflammatory drugs for residual swelling
- Low-dose antidepressants that also work for nerve pain
- Judicious opioid use only when absolutely necessary
Physical Therapy and Rehabilitation
Movement is essential for recovery. We work closely with physical therapists to improve strength, mobility, and scar flexibility while avoiding pain flare-ups.
Psychological and Supportive Care
Because pain after surgery can cause frustration, depression, and anxiety, we integrate:
- Cognitive-behavioral therapy (CBT) for pain coping strategies
- Relaxation and mindfulness techniques to reduce stress responses
- Patient education to help individuals understand their condition and avoid fear-driven immobility
Living with Post-Surgical Pain
For patients, living with ongoing surgical pain can feel like betrayal—the very procedure intended to heal them has instead created a new problem. Many express frustration, hopelessness, or fear of additional surgeries.
As pain specialists, our role is not only to provide treatment but also to validate the patient’s suffering and reassure them that solutions exist. With the right care, most patients can significantly reduce their pain, restore mobility, and regain independence.