Still in pain after surgery: what can be done

If your pain has lasted more than three months since the operation, it is no longer part of normal recovery: it is called chronic post-surgical pain, a recognized condition that — depending on the type of surgery — affects between 10% and 50% of patients. In many cases the pain originates in the nerves (a neuropathic component), which is why ordinary painkillers often fall short. Treatment combines targeted medication with image-guided procedures when there is a clear target; with that approach, most patients achieve a significant reduction in pain, although it does not always disappear completely.

That pain has a name

It is called chronic post-surgical pain: pain that is still present more than three months after the operation, related to the surgical site, once surgical complications have been ruled out and no other cause explains it. From that point on, the mechanisms behind the pain are different from those of acute postoperative pain, which is why it calls for a specific approach.

Two things are worth making clear from the start. First: this is not pain you are "making up," and it does not happen only to you. It is a recognized complication, with a clear neurobiological basis, that affects between 10% and 50% of surgical patients depending on the procedure. Second: persistent pain does not mean the surgery was done badly. It can develop even after technically flawless operations — through injury to small nerves, individual predisposition, or perioperative factors. When there is no surgical complication to explain it — and that is the first thing ruled out during the evaluation — the surgery did its job, and the persistent pain is a separate condition that gets studied and treated on its own track.

Many patients arrive at my office with the same story: the surgery went well, the surgeon is satisfied, the check-ups show nothing… but the pain is still there. Scars that pull, patches of skin with odd sensations, pain triggered by certain movements or by clothing brushing against the skin. That is not "in the patient's head," and it is not "just what surgery feels like": it is chronic post-surgical pain — a well-described condition, common after certain operations, and treatable when it is identified in time.

What it feels like — and which surgeries carry the most risk

How do you recognize it? Some typical clues:

• It starts with the operation and never fully goes away.
• It often feels "strange": burning, electric jolts, tingling, or a scar that hurts at the mere brush of clothing — that is called allodynia, and it points to a neuropathic component.
• Cold, changes in the weather, fatigue, and stress tend to make it worse.
• Left untreated, it ends up taking a toll on sleep, work, and physical activity.

Not every operation carries the same risk. This condition is seen most often after open thoracic surgery and mastectomy — in both, up to half of patients may be left with some degree of chronic pain — after inguinal hernia repair (up to three in ten), and after knee surgery, where 15 to 20% of patients may be left with significant persistent pain despite a mechanically successful procedure. It has also been described after spine surgery, cardiac surgery, and amputations (phantom limb or stump pain). The detailed figures for each type of surgery, and why it develops in each case, are in the dedicated article on this condition →

If your operation was on the lumbar spine, I explain the step-by-step workup and treatment of low back pain in detail on the low back pain page →

Why ordinary painkillers don't touch it

Here lies the key to this condition — and the reason so many people arrive at their appointment frustrated. A large share of chronic post-surgical pain has a neuropathic component: it comes from nerves that were injured or irritated during the operation, not from tissue inflammation. Common anti-inflammatories (ibuprofen, diclofenac) act on tissue inflammation, so against this kind of pain they are of little or no use. Pushing the dose ever higher only adds side effects: gastritis, kidney damage, high blood pressure.

What does work are drugs that act on the mechanisms of the sensitized nerve — medications designed for neuropathic pain, used every day in Pain Medicine — combined with image-guided procedures when there is a clear target. Identifying this component changes the entire strategy and spares you from trialing regimen after regimen that was never going to work. I explain neuropathic pain in depth here →

I am a physician anesthesiologist with postgraduate training in Pain Medicine and interventional pain management, and this is one of the conditions where an accurate diagnosis changes the outcome the most. When a patient describes a scar that "burns" or hurts at the touch of a shirt, that description is already pointing the way before any testing. The problem is almost never that there is no treatment: it is that the correct diagnosis arrives late, after months of painkillers that never had a chance of working.

What can be done

Which tool to use depends on what type of pain predominates (nerve pain, tissue pain, or mixed), where it is located, and how much it limits daily life. The approach is usually multimodal: tools are combined rather than betting everything on a single one. The main ones:

• Medication specifically for neuropathic pain: the foundation of treatment when that component is present. These are not ordinary painkillers — they are drugs that act on the sensitized nerve.
• Image-guided procedures on the affected nerve: selective nerve blocks chosen according to the original surgery (what are nerve blocks →), pulsed radiofrequency when a block confirms the source of the pain but the relief is short-lived (how radiofrequency ablation works →), and scar infiltration when a neuroma reproduces the pain.
• Physical therapy tailored to the condition: work on the scar, mobility, and posture.
• The emotional side: frustration at not getting back the life you expected is part of the picture, and addressing it — with cognitive behavioral therapy, for example — helps when that component weighs heavily.
• Neuromodulation, for cases that do not respond to the above: spinal cord stimulators or dorsal root ganglion blocks.

The details of each tool — which block matches which surgery, when radiofrequency comes into play — are covered in the dedicated article →

I want to be honest about expectations: these treatments treat the pain, and success does not always mean it disappears completely. With a well-executed multimodal approach, most patients achieve a significant reduction in pain and a real improvement in quality of life. The vast majority of these procedures are outpatient and image-guided; the full list of what I do is on the services and procedures page →

There is one signal I use as a thermometer during follow-up: the day a patient tells me about concrete things they have gotten back — a piece of clothing they can wear again, a position they can sleep in, an activity they had given up. That is when I know the plan is working, whatever number they put on the pain scale. And something I say often: don't resign yourself to "that's just how the operation left me." Behind that phrase there is very often a condition with a name, known mechanisms, and concrete tools to treat it.

When to seek help

My criterion is to intervene early: if two or three months have passed since your surgery and the pain persists — especially if it has unusual features such as burning, electric shocks, or pain at light touch — that is the time to seek help. The longer pain remains established, the harder it becomes to reverse; consulting early, between the first and third month, improves the prognosis. Waiting "to see if it goes away on its own" once the condition is six months old makes later treatment more difficult.

One more point, looking ahead: this condition can be prevented to a large degree. If you have one of the higher-risk surgeries ahead of you, good control of acute postoperative pain, multimodal analgesia, and regional anesthesia techniques reduce the likelihood of the pain becoming chronic. It is something that can be planned before the operation, and perioperative medicine now counts it among its areas of focus.

A consultation for post-surgical pain does not interfere with your surgical follow-up: your surgeon continues their part, and I take care of mine — the pain. When needed, we work as a team. I have written a more technical article on this condition, covering in detail why it develops and how it is evaluated: Chronic post-surgical pain: causes and treatments →

Where I see patients: offices in Buenos Aires

I see patients at two locations: Hepta, in San Isidro (Av. Fondo de la Legua 577, in the northern suburbs of Buenos Aires) and CIAREC, in Villa Urquiza (Av. Monroe 4770, Buenos Aires City). I welcome patients from the northern area of Greater Buenos Aires and from the city itself, and I also offer virtual first consultations to point you in the right direction and organize next steps. Consultations are available in English. Phone: +54 9 11 5895-3260.

Dr. Mauricio Casarsa

Physician anesthesiologist. Postgraduate training in Pain Medicine and Interventional Pain Management (UBA — Fundación Dolor; UNLP — CAIDBA). Staff at Hospital Alemán de Buenos Aires.

MN 137.756 (Argentine medical license) · San Isidro · Villa Urquiza