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Glossar

Chronic pain following surgery

Chronic post-operative pain (CPSP) lasts for more than three to six months; it is usually caused by damage to or irritation of nerve fibres during the operation.

Chronic pain following surgery

If pain persists after surgery beyond the normal wound-healing period – usually for longer than three to six months – this is referred to in medical terms as chronic post-operative pain (CPOP). This is usually caused by damage to or irritation of nerve fibres during the operation.

Important note

This article is for information purposes only and is not a substitute for a medical diagnosis or advice. If you are unsure, or if you require a personalised treatment plan, it is essential that you consult a qualified specialist.

After cosmetic or plastic surgery, a certain amount of pain at the wound site is completely normal and part of the healing process. But what happens when the incisions have long since healed, months have passed and the pain still persists? For those affected, this situation is extremely gruelling, especially as they often hear the phrase: „It just needs a bit more time.“

If the pain persists, doctors refer to it as chronic post-operative pain (CPOP). This guide takes your suffering seriously. We explain when pain becomes chronic, why it is usually caused by damaged nerves, and what steps are important to take now to prevent the development of a troublesome ‘pain memory’.

Definition: What is chronic post-operative pain (CPSP)?

Chronic post-surgical pain (CPSP) is defined as pain following a surgical procedure that persists beyond the normal and expected wound healing period – usually for longer than 3 to 6 months. The pain is localised in the surgical area or radiates into the area directly supplied by that nerve.

In most cases, this is no longer the original pain from the wound, but rather a distinct pain condition, often caused by damage to or irritation of nerve fibres (neuropathy) during the procedure.

The Time Check: Acute wound pain vs. chronic pain

In order to assess your condition correctly, the timing and the nature of the pain are crucial.

Acute pain (Day 1 to around Week 6)

  • A throbbing, pulling or pressing pain. It serves a clear protective purpose: it forces you to take care of yourself after the operation (post-operative rest). It usually responds well to standard painkillers (such as ibuprofen) and eases as the healing process progresses.

Chronic pain (from month 3 onwards)

  • The wound has healed on the surface. The pain has lost its protective function. It often feels different: burning, like an electric shock, stabbing or shooting. It is often accompanied by numbness or extreme hypersensitivity of the skin (allodynia). Conventional painkillers are now largely ineffective in such cases.

The main cause: neuropathic pain (nerve damage)

Why does the pain persist? In cosmetic surgery (such as facelifts or breast surgery), tissue has to be cut and repositioned. In the process, very fine skin nerves or even larger nerve bundles can be irritated, pinched, stretched or severed.

  • Nerve injury: A severed nerve attempts to regenerate. If this process is blocked (e.g. by rigid scar tissue), a so-called neuroma (a painful nerve knot) may form, which sends out constant pain signals.
  • Mechanical pressure: In breast augmentation surgery, an implant that is too large can put pressure on nerves. Severe capsular contracture leads to enormous mechanical pressure on all the surrounding tissue, causing chronic pain.
  • Severe scarring: When internal scars harden, they can „trap“ nerves and irritate them with every movement.

The greatest risk: pain memory

Why you shouldn’t just ‚put up with‘ pain

If pain is not treated properly and continues to bombard the central nervous system for weeks or months, the nerve cells in the spinal cord and brain undergo changes. They become hypersensitive. They signal pain even though the original cause at the site of the scar may have healed long ago. A „pain memory“ develops. Once this has become established, it is extremely difficult to ‘erase’. Therefore, if you experience persistent, burning pain, consult a doctor at an early stage!

Treatment options: How can this cycle be broken?

The treatment of CPSP is complex and usually requires a specialist (pain management specialist) or the treating surgeon.

  • Specific medicines: Ordinary painkillers rarely help with nerve pain. Specialised medicines from the groups of anticonvulsants or antidepressants are often used, as they help to reduce the hyperexcitability of the nerves.
  • Local treatments: Special pain-relief plasters (e.g. containing capsaicin or lidocaine) can be applied directly to the painful scar to numb the local nerve endings.
  • Nerve blocks: An anaesthetist can inject anaesthetic directly into the affected nerve bundle.
  • Operative audit: If the pain is caused by a neuroma, severe pressure from an implant or severe capsular fibrosis, further surgery is often necessary to address the mechanical cause (e.g. implant replacement, removal of scar tissue).

Financial protection for pain management and revision surgery

Chronic pain following cosmetic surgery is a serious complication that severely restricts everyday life. The costs of treatment can be enormous. If revision surgery (e.g. the removal of a painful implant) or months of specialised pain management becomes necessary, health insurance funds often do not cover these costs following cosmetic procedures (in accordance with Section 52(2) of the German Social Code, Book V (SGB V)).

To ensure that, in this extremely stressful situation – both physically and mentally – you do not also face financial ruin, it is essential to take out follow-up costs insurance before the initial procedure. This ensures you receive the best possible medical aftercare in the event of such serious complications.

You can find further information on covered procedures on the overview page for treatments and procedures, as well as in the frequently asked questions.

None

Insure against consequential costs

Frequently Asked Questions (FAQ)

Your first point of contact should always be your surgeon, in order to rule out any surgical causes (such as inflammation or problems with implants). If the surgical findings are normal, the most important step is to be referred to a specialist pain clinician.

Patients often describe neuropathic pain as a burning or tingling sensation, like electric shocks, or as a dull, constant throbbing. Allodynia is also a typical symptom: even the slightest touch (e.g. from clothing) on the surgical site is perceived as extremely painful.

No, the type of anaesthesia (general anaesthesia versus local anaesthesia) has no direct influence on the development of CPSP. The decisive factors are surgical trauma (nerve injury) and effective acute pain management in the first few days following the operation.

If internal adhesions are the cause, targeted physiotherapy scar massages can help to loosen the tissue and relieve pressure on the nerves. However, if the nerve has only recently been irritated, massage may make the pain worse. Always check with your doctor first.

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