A recent article in Practical Pain Management shed some light on the problem of post-surgical pain. (1) With 45 million surgery procedures performed every year in the United States, it’s estimated that 10-50% of these surgeries result in some sort of residual pain. Ten percent of these surgeries result in severe chronic pain. While 10% may seem like a low number, that’s 450,000 people per year with post-surgical pain! These people believed they were getting permanent relief only to have the same or similar (maybe worse) struggles with pain after surgery.
The article goes on to suggest possible reasons why so many people are experiencing pain after surgery. A major culprit is nerve damage. Surgery is no simple procedure, it involves cutting through much tissue and sometimes nerves to get to the injured area, resulting in pain after surgery. All of this cutting induces an inflammatory response and alters the peripheral and central nervous system, creating various risks associated with each type of surgery. The longer the surgery takes, the more risk a person is for poor outcomes and post-surgical pain. The article also suggests that genetics, emotional makeup, and gender (women have more post-surgical pain than men) all contribute to pain after surgery.
The numbers clearly show this is a clinical problem that needs to be addressed. This article gave suggestions for safer approaches to various surgeries. Interesting to us, among the surgeries listed are total hip arthroplasty and total knee arthroplasty, with specific surgical techniques mentioned to help prevent post-surgical pain, infection and pain scores. And, as we are seeing among many commentaries and studies, the author strongly suggested assessing the need of surgery before performing it, stating that 10-20% of surgeries are unnecessary.
About Prolotherapy Commentary:
It’s not uncommon for people with post-surgical pain to seek a Prolotherapist. In fact, it’s very common. Almost everyday our Prolotherapist, Ross Hauser, MD, treats someone who has had surgery. It may be a few months or even a year after surgery and the person is still having joint pain or had a recurrence of the same pain. While the author of the article above listed some reasons for post surgical pain, we have our own beliefs as to why people experience pain after surgery.
For one, surgery may not have addressed the root cause of pain. In the case of low back pain, patients who see an orthopedist typically have an MRI done and most likely the MRI showed some sort of disc degeneration or herniation. Well, the truth is that most asymptomatic (pain-free) people have some sort of disc degeneration. In a person with low back pain the cause of pain is usually not the disc, but ligament laxity in the sacroiliac joint. So the surgery missed the whole root cause of pain! Not only did it miss the cause, it probably removed tissue that led to further degeneration and pain in the back. In the case of a hip replacement or knee replacement, pain is often caused from weak ligaments and tendons around the replacement that need to be strengthened. In the case of other joint surgeries, it’s quite possible that ligaments or tendons were damaged during surgery. Remember all the cutting and repairing we mentioned above? When performing surgery, the ligaments are stretched and pulled in order to gain access to the joint. Damage to surrounding structures is a reality with surgery.
So, yes, you may have had unnecessary surgery that didn’t address the root cause. Or maybe you had ligament damage during surgery. Or maybe the surrounding structures to your joint replacement are weak and causing pain. Whatever the reason, Prolotherapy is an excellent treatment for pain after surgery. Prolotherapy is an injection technique that induces a mild inflammation to stimulate the healing cascade naturally found in the body. The inflammation causes blood flow to the injured area, ushering in healing factors and cells to strengthen and grow new cartilage. Ideally, a surgical candidate would get an Prolotherapy evaluation before undergoing surgery to prevent unnecessary surgery. But even in the case of post-surgical pain, Prolotherapy can provide the permanent pain relief desired by the thousands of people who suffer from post surgical pain.
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1. Cintron, L. “Persistent Postsurgical Pain” Practical Pain Management. May 2012: 37-45.