Information & Resources

Find information and resources to help manage your pain.

Get Help & Support

Find the tools you need to
help you manage your pain.

Get Involved

Help make a real difference to people
in the UK living with chronic pain.

About Us

Find out about Pain Concern and how
we can help you.

Chronic pain after surgery

What is chron­ic post-sur­gi­cal pain? How com­mon is it? How is it treat­ed? Pro­fes­sor Julie Bruce & Pro­fes­sor Stephan Schug explain

What is chron­ic post-sur­gi­cal pain?

Let’s start with some def­i­n­i­tions – acute post­op­er­a­tive pain is the pain expe­ri­enced imme­di­ate­ly after an oper­a­tion, usu­al­ly last­ing for days or some­times weeks – this is entire­ly nor­mal and expect­ed. The sur­gi­cal inci­sion and sur­round­ing area can be inflamed and ten­der – again this is fair­ly nor­mal and is impor­tant for wound heal­ing, where tis­sues and mus­cles repair them­selves after injury.

Chron­ic pain is nor­mal­ly con­sid­ered to be pain that per­sists or keeps com­ing back for more than three months or for longer than the expect­ed heal­ing time. Chron­ic pain that devel­ops after an oper­a­tion is often known as ‘chron­ic or per­sis­tent post-sur­gi­cal pain’.

Know­ing when pain becomes chron­ic after surgery is espe­cial­ly dif­fi­cult because many peo­ple have had their surgery to treat a painful con­di­tion, such as a painful her­nia or a long-stand­ing back prob­lem. Is the pain sim­ply a con­tin­u­a­tion of the old pain, or is it new? And, even if it is new, is it relat­ed to the surgery?

Some­times it is obvi­ous that some­thing has changed – nerve dam­age after an oper­a­tion for her­nia repair can be quite dif­fer­ent from the dis­com­fort felt before the oper­a­tion. Anoth­er exam­ple is per­sis­tent tin­gling nerve pain in the chest wall after heart bypass surgery, which is very dif­fer­ent from angi­na pain expe­ri­enced before heart surgery.

Some­times it is very dif­fi­cult to tell the pains apart, espe­cial­ly if the orig­i­nal pain (that the oper­a­tion was done to treat) was not in fact helped by the surgery. How­ev­er, these are the fea­tures that can allow doc­tors to tell if you have chron­ic post-sur­gi­cal pain:

  • The pain devel­ops after a sur­gi­cal operation
  • The pain lasts for at least three months after the operation
  • Your pain is not thought to be from oth­er caus­es, such as an infec­tion or cancer
  • Your pain is not the same as the pain from the orig­i­nal condition.

Sur­gi­cal fol­low-up can be lim­it­ed to one post­op­er­a­tive appoint­ment, thus a fol­low-up clin­ic at approx­i­mate­ly 8 weeks, to deter­mine sur­gi­cal ‘suc­cess’. Patients are then dis­charged and man­aged by the pri­ma­ry care team.

What type of pain is it?

The type of pain can depend on the oper­a­tion itself, because the painful symp­toms often relate to the dis­tri­b­u­tion of nerves in the area of the oper­a­tion. For exam­ple, after groin her­nia repair surgery, peo­ple have report­ed pain down the front and inside of the thigh, or in the tes­ti­cles. This may relate to poten­tial irri­ta­tion of nerves in the groin dur­ing sur­gi­cal repair of the hernia.

We now under­stand more about nerve pain or ‘neu­ro­path­ic pain’ which can arise from nerve injury. Typ­i­cal char­ac­ter­is­tics and descrip­tions of neu­ro­path­ic pain include stab­bing, tin­gling, numb­ness, altered sen­sa­tions and prob­lems with sen­si­tiv­i­ty. It is not always pos­si­ble to avoid nerve dam­age dur­ing an oper­a­tion, espe­cial­ly dur­ing can­cer surgery when removal of the tumour takes priority.

Treat­ment of chron­ic post-sur­gi­cal pain

Treat­ment does not depend upon what sort of surgery you have had but rather on the mech­a­nism that results in you hav­ing the per­sis­tent pain. For exam­ple, not every­one who suf­fers pain fol­low­ing a mas­tec­to­my will have the same ‘type’ of pain or for the same under­ly­ing rea­son. The treat­ment will depend on the char­ac­ter­is­tics of the pain and also the pos­si­ble rea­son for the pain devel­op­ing and not on the fact that the sur­gi­cal oper­a­tion hap­pened to be a mastectomy.

It is impor­tant that the health­care pro­fes­sion­al lis­tens to your sto­ry, per­forms a thor­ough exam­i­na­tion and allows you to give a full expla­na­tion of your symp­toms. The health­care pro­fes­sion­al then gains an under­stand­ing of the prob­lem and the impact the pain has on your dai­ly life. Patients often report find­ing this approach help­ful in itself. Often they feel that, in the past, their symp­toms have been dis­missed and not tak­en seri­ous­ly. Some­times, peo­ple have been told that the pain will go away soon after the oper­a­tion and this caus­es mis­trust and resentment.

The best treat­ment for the pain will depend upon the mech­a­nism caus­ing it. Treat­ments include: tri­cyclic anti­de­pres­sants, anti­con­vul­sants, painkillers, TENS (tran­scu­ta­neous elec­tri­cal nerve stim­u­la­tion) and injec­tions. Based on our clin­i­cal expe­ri­ence, nerve destruc­tion (periph­er­al nerve abla­tion) should not be used in the man­age­ment of chron­ic post-sur­gi­cal pain.

It is not always pos­si­ble to con­trol the pain and oth­er symp­toms ade­quate­ly. In such cas­es, a psy­chol­o­gy-based pain man­age­ment approach or phys­io­ther­a­py sup­port can help you to cope with your symp­toms and reduce the impact on your dai­ly life.

How com­mon is it?

A sur­vey asked over 5,000 patients attend­ing pain clin­ics across Scot­land and the north of Eng­land car­ried out in the late 1990s about their rea­sons for atten­dance. Twen­ty per cent of patients thought that surgery was one of the caus­es of their pain and, of these patients, half thought it was the only cause. Until this report was pub­lished, chron­ic pain after surgery was thought to be rare. This is pos­si­bly because few patients were asked about per­sis­tent pain after their operation.

On aver­age about 30 per cent of patients expe­ri­ence chron­ic pain after surgery, although this ranges from those with mild symp­toms to those with more severe pain. Over­all, only about five per cent of peo­ple report severe inten­si­ty pain, but five per cent is a sig­nif­i­cant num­ber when you con­sid­er the huge num­ber of oper­a­tions con­duct­ed across the UK and globally.

Are there risk factors?

We are begin­ning to under­stand more about risk fac­tors for chron­ic post-sur­gi­cal pain. As well as the impact on qual­i­ty of life for those affect­ed, chron­ic pain is dif­fi­cult and cost­ly to treat, so under­stand­ing more about who is at risk of devel­op­ing chron­ic pain after surgery is impor­tant as it may help in pre­vent­ing the condition.

Cer­tain groups of patients may be more at risk from pain after surgery than oth­ers. Women are more like­ly to expe­ri­ence chron­ic pain than men, although this is not always the case after surgery. Stud­ies sug­gest women are more like­ly to report more severe acute post­op­er­a­tive pain, but the evi­dence for chron­ic pain is less certain.

Younger patients do seem to be at greater risk of chron­ic post-sur­gi­cal pain than old­er patients – this has been found after many dif­fer­ent oper­a­tions. This find­ing might be explained by the fact that younger peo­ple are often more active and are work­ing, thus hav­ing per­sis­tent pain could have a greater impact on their dai­ly life com­pared to old­er peo­ple who are often less active. Or it may relate to nerve and tis­sue changes (how we react to pain) as we age.

Peo­ple with oth­er chron­ic pains are at greater risk of devel­op­ing chron­ic pain after surgery. This may include patients who suf­fer from such con­di­tions as chron­ic low back pain, Raynaud’s dis­ease, irri­ta­ble bow­el syn­drome, migraine, fibromyal­gia and oth­er con­di­tions. Changes in the ner­vous sys­tem may well lie behind many of these con­di­tions. There is grow­ing research on the genet­ics of pain, sug­gest­ing that some patients may be more sus­cep­ti­ble to pain con­di­tions than others.

Patients who are more anx­ious and wor­ried about their oper­a­tion are at greater risk of acute and chron­ic post­op­er­a­tive pain – so exces­sive wor­ry and anx­i­ety is a risk fac­tor. Pre­op­er­a­tive prepa­ra­tion is vital; for exam­ple, a clear expla­na­tion about the oper­a­tion and recov­ery process set­ting out the risks and ben­e­fits is an essen­tial part of sur­gi­cal treat­ment. Many hos­pi­tals run pre­op­er­a­tive clin­ics where­by patients attend for tests in advance of their oper­a­tion. This is an oppor­tu­ni­ty for care­ful expla­na­tion and dis­cus­sion between the patient and health care team.

Final­ly, one of the strongest and most con­sis­tent risk fac­tors for post-sur­gi­cal pain is the sever­i­ty of acute post­op­er­a­tive pain in the days and weeks after an oper­a­tion. Treat­ment and ade­quate con­trol of acute pain imme­di­ate­ly after surgery is very impor­tant and may ‘damp­en’ the pain response, pre­vent­ing longer term symptoms.

More aware­ness needed

It is clear that chron­ic post-sur­gi­cal pain is com­mon, can be severe and may result in dis­tress and dis­abil­i­ty for patients. Look­ing at the whole spec­trum of chron­ic pain con­di­tions after surgery, it is very unlike­ly that the cause of the pain is some­thing that the sur­geon has done wrong. It seems more like­ly that this is the inevitable result of surgery in a cer­tain per­cent­age of patients – approx­i­mate­ly 30 per cent of patients expe­ri­ence chron­ic post-sur­gi­cal pain of vary­ing sever­i­ty in the first year after an operation.

If it were more wide­ly accept­ed that chron­ic pain can arise after surgery, some patients might decide against hav­ing oper­a­tions that aren’t entire­ly nec­es­sary. Sur­geons, who are undoubt­ed­ly try­ing to do the best for their patients, would also be reas­sured that pain is prob­a­bly not the result of sur­gi­cal error. Anoth­er ben­e­fit is that patients would have their pain acknowl­edged and would be treat­ed more sympathetically.

Over the last 30 years, there has been a huge increase in med­ical research inves­ti­gat­ing the char­ac­ter­is­tics and poten­tial caus­es of chron­ic pain after surgery – this has helped raise aware­ness amongst health­care pro­fes­sion­als and patients alike. There is still, how­ev­er, much more work to be done to improve our abil­i­ty to pre­vent peo­ple from devel­op­ing chron­ic pain after surgery and to make sure every­one affect­ed by this all too com­mon con­di­tion receives swift diag­no­sis and treatment.

Final­ly, let’s look at some exam­ples of dif­fer­ent operations…

Pain after her­nia surgery

Inguinal (groin) her­nia is a com­mon con­di­tion with an inci­dence of six per cent to 12 per cent in adult males. It affects men more often that women. The con­di­tion presents as a lump in the groin, due to a pro­tru­sion of intes­tine through a weak­ness in the abdom­i­nal wall in the groin. This lump can affect dai­ly activ­i­ties and is often, but not always, painful.

Surgery to repair inguinal her­nia is one of the most com­mon­ly per­formed oper­a­tions. Some sur­geons use key-hole or laparo­scop­ic surgery rather than an open inci­sion. A mesh is often used to repair the abdom­i­nal wall weak­ness, secured in places either using stich­es, glue or sta­ples. There is a small risk that the nerves in the groin can become irri­tat­ed or inflamed by the implant or inter­nal stiches.

Chron­ic pain after inguinal repair surgery is now a well-recog­nised con­di­tion – it is one of the most wide­ly report­ed sur­gi­cal con­di­tions with hun­dreds of arti­cles report­ing preva­lence of up to and around 30 per cent. Approx­i­mate­ly 5 to 10 per cent of patients report pain after their her­nia oper­a­tion that inter­feres with dai­ly liv­ing. There is now guid­ance rec­om­mend­ing that it is safe for sur­geons to ‘watch and wait’ with some patients who have a small pain-free lump, as long as the her­nia doesn’t impact too much on their dai­ly activities.

Pain after chest surgery

When you con­sid­er what is involved in sur­gi­cal­ly open­ing the chest (tho­ra­co­to­my), it is not sur­pris­ing that many patients suf­fer long-term pain after­wards. In order to gain access to the chest, the sur­geon has to either remove part of a rib or spread the ribs apart. This inevitably caus­es dam­age to bone and nerves lying along the ribcage.

Expe­ri­ence sug­gests that many of the worst pain syn­dromes may be caused by par­tial nerve injury – thus it may be that a ‘clean’ cut of the nerve has a bet­ter long-term out­come, although this can result in numb­ness and loss of sen­sa­tion. Although pain after chest surgery is fair­ly com­mon, the sever­i­ty of pain varies. In one study, 15 per cent of patients with chron­ic pain after chest surgery were suf­fi­cient­ly trou­bled to war­rant refer­ral to a pain clinic.

Pain after amputation

Pain after limb ampu­ta­tion is a well-recog­nised post-sur­gi­cal pain con­di­tion. After limb ampu­ta­tion, the pain can be either stump pain or phan­tom pain (pain felt in the limb that is no longer there). In stump pain, patients often report a ten­der spot on the stump and this has led many sur­geons to per­form fur­ther oper­a­tions to try and find the cause. Patients in the past have fre­quent­ly had fur­ther ampu­ta­tions in the mis­tak­en belief that this would cure the prob­lem. Such oper­a­tions rarely help stump pain and some­times make it worse or make it more dif­fi­cult for the patient to wear an arti­fi­cial limb.

Phan­tom limb is a feel­ing or sen­sa­tion that the limb is still there, this is nor­mal and does not require treat­ment. But phan­tom limb pain (pain in the limb which is no longer there) can affect between 50 to 85 per cent of amputees. It usu­al­ly starts in the first few weeks after surgery. Stud­ies sug­gest that painful phan­tom symp­toms can last between one hour and 15 hours a day and can vary between five days a month and 20 days. Pain sever­i­ty can also be very variable.

It is now acknowl­edged that chil­dren get phan­tom limb pain and that peo­ple born with­out limbs also suf­fer from it. Recent research has shown that part of the pain after ampu­ta­tion aris­es due to activ­i­ty in the brain itself and this under­lines the futil­i­ty of meth­ods of treat­ment aimed direct­ly at the stump.

Oth­er chron­ic post-sur­gi­cal pain syndromes

Oth­er oper­a­tions with known risks of chron­ic pain include vasec­to­my, joint replace­ment surgery, spinal surgery for back pain and breast surgery for can­cer treat­ment. Oth­er leaflets in this series dis­cuss strate­gies for the man­age­ment of chron­ic pain.

Pro­fes­sor Bruce is based at the War­wick Clin­i­cal Tri­als Unit, Uni­ver­si­ty of Warwick.

Pro­fes­sor Stephan Schug is based at the Uni­ver­si­ty of West­ern Aus­tralia, Perth, WA.

This leaflet is an update of a pre­vi­ous leaflet pub­lished by Dr Bill Macrae, now retired.

If you would like to know more about the sources of evi­dence con­sult­ed for this pub­li­ca­tion, please click here.

Chron­ic Pain after Surgery © Copy­right Julie Bruce & Stephan Schug. All rights reserved. Revised June 2019. To be reviewed June 2022. First pub­lished June 2015.


Pain after abdom­i­nal surgery for inter­nal large cyst above colosto­my stoma.

I found your arti­cle help­ful thank you. I have been suf­fer­ing sev­er neu­ro­path­ic and inter­nal scar tis­sue pain for the past three years after hav­ing had mul­ti­ple Inguinal Her­nia sur­gi­cal repairs. My sur­geon also believes that it’s pos­si­ble that my body is reject­ing the exten­sive amount of mesh that has been implant­ed as I also expe­ri­ence peri­od­i­cal sharp, stab­bing type pains. Even though my doc­tors have tried numer­ous types pain med­ica­tion, as well as nerve block­ers and Ket­a­mine infu­sions, for the most part, my pain lev­els are nev­er below a 7/10! Dis­trac­tions tend to help but I’m start­ing to get to the point where I feel as though the con­stant burn­ing across my abdomen is dri­ving me insane! Any new help would be appre­ci­at­ed thank you.

Pain has start­ed these last years in the area where I broke and oper­at­ed my left foot over ten years ago. The pain comes and goes. Dur­ing days when I notice my Qi is stagnated/stuck in me, I feel aches in my body much more. I can tell my Qi is stuck/not flow­ing in many ways.

I had a major back surgery done in Oct 2019. I had her­ni­at­ed and bulging discs since 1992 and had fell in 2017 which made my con­di­tion worse. Symp­toms include sci­at­i­ca, fluc­tu­at­ing numb­ness in left leg, pain in back, nar­row­ing of spine. I had a laminec­to­my in Oct 2019 and after surgery nerve pain in right foot toe. I twist­ed my ankle 4 times. I expe­ri­ence back pain and pain through­out my right foot, ankle has swollen a few times and toes. I loss sen­sa­tion to cold areas in cer­tain soot ontop of right foot. Xray and blood tests are nor­mal. An MRI with dye imag­ing of spine and MRI of ankle has been ordered

Hi there

I would like to ask you how do you feel after your pro­ce­dure regard­ing your back and sciatica

Con­stant pain under left rib cage 5 months after Colon Resec­tion surgery. Has not been diag­nosed as chron­ic pain . Had all kinds of tests run can’t find any­thing wrong. Sur­geon dis­missed it . Won’t give me any more pain meds. But still have bad pain every day !! It nev­er stops !

hi stel­la , i know how you feel i an the same , strange …me also 5 months after same op, i take over counter med , i also have tin­gle x ten­der sor­ness when i lie down 

just none stop

Since my her­nia op I always have pain also my sur­geon cut my abdo­min­is rec­tus and I lost a lot of blood and need­ed two blood trans­fu­sions and also looked preg­nant I spent months recov­er­ing he did admit he could have been more care­ful I was very unhap­py with the outcome

Linda bayley Roberts

I had a Elec­tive Bio­pros­thet­ic Tri­cus­pid Valve Replace­ment on 20/1020 and on 27/10/2020 I was fit­ted with a Dual Cham­ber Per­ma­nent Pace­mak­er. I was won­der­ing how long does the pain last. I’m still get­ting pains in my chest and my breast and 2 wks ago I was told that I have nerve end­ings dam­age in my hand and it com­ing from my neck

Hi Lin­da,

I’m sor­ry, we can­not give advice spe­cif­ic to your health, that can only come from your health­care pro­fes­sion­al. How­ev­er, please do con­tact our helpline, where our trained vol­un­teers will be able to lis­ten to you and advise you appro­pri­ate­ly if they are able. The tele­phone num­ber and email address is on our helpline page.

James, Pain Concern

I had an Enu­cle­ation of the pan­creas that was a neu­roen­docrine tumor. I had to have it done sur­gi­cal­ly due to the fact that it was on the head, so it couldn’t be done laparo­scop­i­cal­ly. It had now been 7 weeks post op. The inci­sion is healed on the out­side, but it is so ten­der to the touch, some­times just my shirt or sport bra touch­ing it is painful. Is this normal?

My daugh­ter had her appen­dix out near­ly 12 week­snow and was back in hos­pi­tal twice with pain in her side they said it was a bad blad­der infec­tion and kid­ney infec­tion back in again 4 weeks latwr told me bloods are fine s t scan clear ultra­sound clear sebd gome still has the pain nau­sea no appetite said it was mus­cu­lar pain

Comments are closed.