Scar Pain

What Are Scars?

Every time an injury to the skin penetrates through to the dermis layer, a scar will occur as a result of the healing process, this is the body’s way of naturally repairing itself. In response to a wound, the body produces collagen, a protein of which the rest of our skin is made from. Scar tissue however, looks and feels different – some researchers suggest that this is due to its alignment, which differs from that of normal skin tissue. One possible theory is that scar tissue forms in such a way to optimise the speed of the healing process, thus reducing the risk of infection and pain.

Scar Tissue Pain

Although many scars are trivial, some are extremely unpleasant causing not only aesthetic displeasure but also chronically painful symptoms. Scar pain, whether it be from an operative, or traumatic cause, is very common. The symptoms and signs can be similar to those of Complex Regional Pain Syndrome. They include pain, itching, swelling, tightness, restriction of movement, skin colour changes, allodynia or hypersensitivity to touch, and hyperalgesia or marked pain to deeper palpation.

Scar tissue pain is usually caused by damage to the nerves or when a nerve is compressed by the scar. In some cases, such as amputations, neuromas (painful swellings) may form at the end of severed nerves, firing uncontrollable pain signals to the brain. Pain in stump scarring is relatively common.

Common Causes of Scars

  • Surgery
  • Burns
  • Cuts and other injuries
  • Injections
  • A complication of another condition such as acne, chicken pox or shingles

Specific areas of the body are naturally more prone to scarring, namely the back, chest, shoulder tip and earlobes.

Different Types of Scars

Flat or Widespread Scars

Characterised by a lack of elevation or thickening, these scars generally heal well, usually within two years and don’t usually produce painful symptoms. Depending on the individual’s skin tone these scars may be darker or lighter in colour.

Atrophic Scars

Usually small and round with an indented centre, atrophic scars are flat and depressed below the surrounding skin. They frequently occur after severe acne or chicken pox.

Problem Scars

The following scars are more commonly associated with painful symptoms.

Keloid Scars

These scars continue to grow over time and often occur after a simple excision – they spread beyond the margins of the original wound, invading the surrounding skin and are always raised. They are the result of an excess of collagen production during the healing process and are usually shiny, hard and rubbery in their appearance, they may red or purple in colour before turning brown. Keloids sometimes don’t form for several months or even years after the initial injury. For many people keloids cause aesthetic issues, however for some people they also have painful symptoms which may include, burning sensations, itchiness, pain and tenderness amongst others.

Hypertrophic Scars

Elevated and raised in their appearance, hypertrophic scars are similar in appearance to keloids, but are distinguished by the fact that they heal within the boundaries of the original wound; a keloid scar grows with time, the hypertrophic scar however, generally regresses spontaneously following initial injury, it may also cause painful symptoms or restrict movement depending on the location. Symptoms may include, redness, inflammation, itchiness, pain and sensitivity.

Scar Contractures

A biological process which usually occurs following 2nd or 3rd degree burns. The burn injury causes the surrounding skin tissue to contract around the wound, a scar forms over the wound resulting in a contracture which often restricts movement especially if it occurs at a joint. Skin contracture is frequently accompanied by severe chronic pain, significantly affecting the patient’s quality of life.

Post Herpetic Neuralgia

Pain felt in the area of skin previously affected by shingles is common. For more information on the complications of Shingles and Post Herpetic Neuralgia.

Treatment for Scar Tissue Pain

Pain management plans are devised for specific scar types on an individual patient basis.

Topical Medications

Treatment is initially directed to the scar itself, and can be in the form of topical lignocaine-impregnated patches, (a topical anaesthetic) at its simplest.

Compression Therapy

Silicon sheeting is placed over the scar for several hours per day in an attempt to reduce the swelling and size.

Botox

The injection of painful scars with Botox can be remarkably effective. Indeed, there is an evidence base for this, as there is for the use of Botox in the treatment of the allodynia of post herpetic neuralgia.

Pulsed Radiofrequency and P.E.N.S.

This can be useful in the treatment of hypertrophic or keloid scarring, neuromas can also respond well to pulsed radiofrequency treatment and P.E.N.S.

Corticosteroid Injections

These may be used to reduce swelling and inflammation in keloid or hypertrophic scars.

Surgery

Reconstructive scar surgery may be beneficial depending on several factors of which the surgeon would evaluate, in order to determine if the wound healing would be more favourable than on the first occasion.

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