Chronic pain after surgery: Is it normal?

As per the International Association For The Study Of Pain, pain after surgery is common and expected, with 20-40% of patients experiencing severe pain on the first day post-operation.

When it comes to chronic pain after types of surgeries, the national library of medicine showed in studies that despite total knee replacement being a widely successful surgery technically, about 20% of patients continue to experience chronic pain and discomfort post-surgery.

It also showed that chronic pain after spine surgery (CPSS) often presents as persistent low back pain and/or radiating leg pain, affecting approximately 8–40% of patients who undergo lumbar spine surgery.

What Is Chronic Post-Surgical Pain (CPSP)?

Chronic post-surgical pain (CPSP) is pain that starts after surgery and lasts for at least 2–3 months. Before diagnosing CPSP, doctors rule out other causes such as infections or cancer coming back.

It affects about 2–10% of adults after surgery, but the risk can be much higher for certain operations like amputations, chest surgery, or breast removal. CPSP often involves nerve pain, which can happen when nerves are damaged during surgery or when the nervous system stays overly sensitive.

You’re more likely to develop CPSP if you had very strong pain right after surgery, already had pain before surgery, had certain types of surgical techniques, a long operation, or if you have certain psychological or genetic risk factors. CPSP can seriously impact daily life, limiting movement and affecting emotional wellbeing.

Prevention and Management

Prevention focuses on protecting nerves, using less invasive surgical methods, and controlling pain well before, during, and after the operation. A “multimodal” approach: mixing different treatments like certain nerve pain medicines, regional anesthesia, and non-drug therapies; can lower the risk.

If CPSP develops, treatment can include nerve pain medications, physiotherapy, psychological support (like CBT), and procedures such as nerve blocks or electrical nerve stimulation. Because CPSP is complex, the best results come from spotting high-risk patients early and working as a team: surgeons, anesthetists, and pain specialists; to create a plan that treats both the body and mind.

Why Does Chronic Pain Happen After Surgery in the First Place?

Pain after surgery usually occurs due to inflammation in the part of the body that was operated on. This type of pain is commonly known as acute post-surgical pain and lasts less than 3 months. Inflammation and acute pain are a natural part of the body’s healing process.

Some people may have pain for a longer period of time after surgery. When pain lasts more than three months after surgery, it is a sign that the person may have chronic post-surgical pain (CPSP). About 5 -10% of patients who had major surgery go on to develop CPSP.

Chronic Post-Surgical Pain: How to deal with it?

Effective pain management is about making pain bearable, not eliminating it completely.

Traditional numeric pain rating scales (0–10) are widely used but fail to capture the full complexity of the pain experience, which is multidimensional; affecting biological, psychological, and social aspects of patients’ lives.

Research shows that patients’ pain experiences are unique and that assessing pain’s impact on function (like mood, movement, and sleep) alongside intensity provides a clearer picture. Pain that interferes with daily function demands stricter control.

Inadequate pain management can worsen recovery and increase complications, highlighting the importance of assessing both pain intensity and its functional impact.

Are You a Candidate for Chronic Post-Surgical Pain Management, and When Should You Seek Help?

You might be a candidate for chronic post-surgical pain management if:

• Your pain began or got worse after surgery.
• It has lasted more than 3 months beyond the expected healing period.
• The discomfort is at the surgery site or spreads to nearby areas.
• The pain feels nerve-related — such as tingling, burning, or shooting sensations.
• You notice pain that’s unusually intense (hyperalgesia) or triggered by normally non-painful actions (allodynia).

If your doctor has already ruled out other causes (such as infection or cancer recurrence), your symptoms could point to persistent post-surgical pain (PPSP).

This condition is more common than many realize:
• Up to 57% of patients after mastectomy
• Around 40% after spinal surgery
• Up to 44% after knee replacement
• Up to 27% after hip replacement

Modern Treatment Options for Chronic Post-Surgical Pain Around the World

While modern surgical techniques have greatly improved acute pain control during and after operations, chronic post-surgical pain remains a significant challenge worldwide. For some patients, pain persists for months after surgery due to factors such as nerve injury, central nervous system sensitization, and inadequate management during the recovery period at home. Individualized pain management-especially in the subacute phase-has shown promise in reducing the risk of persistent pain, leading to emerging models like specialized follow-up clinics that monitor high-risk patients and provide targeted treatments beyond hospital discharge.

Treatment for chronic pain after knee surgery

Chronic pain after knee surgery is pain that lasts beyond the normal healing period, often for months, and can be caused by nerve injury, inflammation, or other factors not directly related to the surgery itself.

Source: https://youtu.be/G8UaVioH4wY?si=u9EPjWABv7khagtE

1. Accurate Diagnosis
It’s essential first to rule out other causes like infection or implant problems. Identifying whether the pain is neuropathic (nerve-related) or due to other issues guides effective treatment.

2. Medications

• Anti-inflammatory drugs (NSAIDs) to reduce swelling and pain
• Medications targeting nerve pain (e.g., gabapentin or pregabalin)
• Sometimes low-dose antidepressants help manage nerve pain and improve mood.

3. Physical Therapy

Rehabilitation and exercises improve joint mobility, strengthen muscles around the knee, and help reduce pain by addressing stiffness and weakness.

4. Interventional Treatments
If medication and therapy aren’t enough, options like nerve blocks, radiofrequency ablations or spinal cord stimulation may be recommended.

5. Psychological Support
Chronic pain often leads to emotional distress. Counseling or cognitive-behavioral therapy (CBT) can help patients manage anxiety, depression, and the mental toll of ongoing pain.

6. Multidisciplinary Approach
The best results come from coordinated care involving surgeons, pain specialists, therapists, and mental health professionals working together to tailor treatment.

7. Patient Engagement
Active participation in rehab and pain management plans improves recovery and quality of life.

Treatment for chronic pain after spine surgery

Chronic pain after spine surgery is multifactorial and challenging. Effective treatment depends on thorough diagnosis, individualized care plans, and a combination of conservative therapies, lifestyle modifications, and advanced interventions like spinal cord stimulation when appropriate. Revision surgery is rarely the first or best solution and should be approached cautiously. Successful management improves quality of life, functional ability, and overall wellbeing.

Chronic pain after vertebral column surgery, often referred to as Failed Back Surgery Syndrome (FBSS), is a complex condition involving persistent or new pain following surgery. This pain can stem from many causes such as surgical complications (infection, nerve injury, hardware failure, pseudoarthrosis), scar tissue compressing nerves, spinal instability, re-herniation of discs, or increased stress on spinal segments adjacent to the surgical site (transitional syndrome). Psychosocial factors like depression, anxiety, and lifestyle also heavily influence pain persistence and recovery.

Incidence of persistent pain after spine surgery remains high — up to 40% after the first surgery, and even higher after reoperations. Managing this condition requires a systematic, multidisciplinary approach tailored to the individual.

Why Does Chronic Pain Persist?

• Scar tissue compressing nerves.
  Unsuccessful fusion or hardware failure.
  New or recurrent spinal problems near the surgery site.
  Redistribution of mechanical load to adjacent discs or vertebrae.
  Patient-related factors such as mental health, smoking, obesity, and non-adherence to post-op instructions.

Advanced Treatments

1. Spinal Cord Stimulation (SCS)

• An implantable device delivers controlled electrical pulses near the spinal cord to “distract” pain signals.
• Typically trialed first to assess effectiveness before permanent implantation.
• Emerging techniques (burst, high-frequency, dorsal root ganglion stimulation) offer multiple options for refractory chronic pain.

2. Revision Surgery

• Considered only when there is clear evidence of mechanical failure (hardware issues, pseudoarthrosis) or instability.
• Carries a higher risk of persistent pain and is generally a last resort.

Source: https://youtu.be/9OPdPKh7MP4?si=dYsRlgo6Q_KYZNMn

Preventive and Supportive Measures

• Early Mobilization & Lung Care: To prevent complications like blood clots and pneumonia, patients are encouraged to move soon after surgery and perform breathing exercises.
• Smoking Cessation: Smoking significantly worsens outcomes and increases risk of failed surgery.
• Mental Health Support: Depression and anxiety correlate with worse pain outcomes; psychological care can improve recovery.
• Healthy Lifestyle: Maintaining proper nutrition, healthy weight, and exercise reduces strain on the spine and supports healing.
• Patient Education and Compliance: Understanding postoperative expectations and strictly following medical advice are crucial to avoid re-injury and optimize recovery.

Where to Get Help for Chronic Post-Surgical Pain in Amman, Jordan

Living with chronic pain after surgery is not your only option: you can choose a different path.

While painkillers may dull the discomfort temporarily, they often come with unwanted side effects and do not address the root cause. At our clinic, we offer spinal cord stimulation; a modern, minimally invasive treatment that targets pain at its source by interrupting pain signals before they reach the brain. This approach can help you regain mobility, improve quality of life, and reduce reliance on medication.

Source: https://youtu.be/SvBdmkqDSh0?si=8Ym7nl5PCw-TPu0J

Dr. Samer’s clinic specializes in root-cause pain management: same-day, fast treatment with short recovery, no opioids, no surgeries, no long hospital stays.

Book your chronic post-surgical pain treatment appointment in Amman – Jordan

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