Cicatricial neuropathy

A new concept: Cicatricial neuropathy.

The most misunderstood and yet the most frequent of the neuropathies responsible for neuropathic pain.

Indeed, a recent study carried out by a Parisian pain center finds an incidence between 2.5% and 5% of operated patients.

They therefore affect around 500,000 people a year in France (1).
It is related to a trauma, a wound or a surgical intervention.
It gives variable pictures, from a simple gene to a persistent handicap.

Characteristic :

  • Appears in the months following trauma, surgery.
  • The pain is accompanied by dysaesthesia, paresthesia, burning, electric shocks sometimes sensation of bone pain.
  • Clinical examination finds hyperesthesia and/or hypoesthesia in the area.
  • Depending on the area affected, an accompanying myofascial syndrome is not uncommon.
  • Complementary examinations are normal (blood test, X-ray, ultrasound, scanner, MRI)
  • Only the bone scan is sometimes positive but has no value in this context.
  • Electromyogram and evoked potentials are normal.
  • The size of the surgery or trauma does not prejudge the size of the painful area and its consequences.
  • May be responsible for visceral symptoms depending on the location of the skin lesion: constipation, bladder instability.

Diagnostic :

  • The diagnosis is only clinical.
  • The local examination of the patient finds the neurological signs described above.
  • The territory affected may correspond to a known but often truncated neurological path (absence of complete involvement of the territory: truncated sciatica, truncated intercostal neuralgia) or be divided into “oil stains”.
  • In the painful area there is a scar, even minimal (trocar path for example)
  • Examination of the scarred area by the rolling palpation method triggers a sharp pain which sometimes reproduces all the pain described by the patient.
  • Can join the neurological picture of vasomotor signs and sometimes edema realizing true algodystrophy (CRPS)

An algorithm to help diagnose these pains is available in the part of the site reserved for doctors.

Dr Yves Guenard

Post operative chronic pain