Persistent Post-Surgical and Post-Traumatic Pain

Persistent post-surgical pain is pain that develops or increases after surgery and persists or recurs for at least three months, when the pain cannot be better explained by another condition. It can follow many types of surgery, including hernia repair, thoracic surgery, amputation, joint replacement and spinal surgery. Persistent post-traumatic pain similarly continues or recurs beyond three months after an injury.

The pain may be nociceptive, neuropathic, nociplastic or mixed. Nerve injury can produce burning, shooting or electric sensations, while ongoing inflammation, structural problems, scar-related pain or altered pain processing may also contribute. Risk factors include the nature and extent of the procedure or injury, severe acute pain and pre-existing pain, but persistent pain can occur even when surgery and recovery are otherwise uncomplicated.

Assessment focuses on identifying treatable causes and understanding the dominant pain mechanisms, rather than assuming that persistent pain means the original procedure was unsuccessful. Management may include rehabilitation, education, medication, psychological strategies and selected interventions such as nerve blocks or neuromodulation when appropriate. Early assessment of pain that is not settling as expected can help identify complications and provide timely rehabilitation.