What happens to the pain after surgery?
There are three main groups of patients after nerve surgery:
- Most patients have significantly less nerve pain immediately after surgery. They will tell us that they have incision/surgery pain, but they can tell the difference that the original nerve pain is better. Surgical pain is usually greatly improved in 5-7 days, almost completely by 6 weeks, and still present to a small degree for 2-3 months.
- Some patients take a few months (3-6 months or more) to see improvement in their nerve pain. Several factors are involved:
- The nerve has just been cut and is traumatized – it is telling the brain about this new injury.
- Phantom Pain: This is usually a slightly different type of pain, with “pins and needles” and extra sensitivity to light touch on the skin.
- Collateral Sprouting: When a nerve is cut, the area of skin it innervates becomes less sensitive / numb. Surrounding nerves start to grow into the new area of numbness, and this process is painful. There can be a burning “ring” around the new area of numbness. This process can take several months to go away. [Imagine a hedge and one bush in the middle of the row is removed. The bushes on either side grow in to the empty space, in a scraggly way. They eventually grow as far as they can and stop.]
- Some patients never achieve significant pain relief. Central sensitization is the process where the brain has been seeing the same pain signals from the same spot for so long, that it changes itself, and stays in “pain mode” despite disconnecting the nerve that was injured. Fortunately, this group of patients is small.
