An Overview of Nerve Pain After Abdominal Surgery

Having abdominal surgery can sometimes lead to chronic abdominal nerve pain or chronic pelvic nerve pain.

During surgeries like an appendectomy, gynecological surgery, or hernia repair, it's possible for abdominal or pelvic nerves to get cut, stretched, or damaged in another way.

This complication is called surgically-induced neuropathic pain (SINP). It is unclear how often it happens, but researchers are starting to learn that nerve pain after surgery is probably common.

The statistics can be worrisome if you're planning to have surgery, but you might be able to do things to reduce the risk. At the same time, researchers are looking for ways to reduce the risk of SINP and effectively treat it if it does happen.

This article will go over what you need to know about the causes of SINP, how it is diagnosed, and how it's treated.

Causes

Sometimes, having surgery can damage nerves. This can lead to pain after surgery (postoperative pain).

For example, damage to the ilioinguinal, iliohypogastric, or genitofemoral nerves has been linked to postoperative pelvic pain.

With abdominal surgery, there is not always a simple relationship between nerve damage and pain after surgery. Damage to a specific nerve is not necessarily the cause of all postoperative abdominal or pelvic pain.

Severed Nerves

The iliohypogastric and ilioinguinal nerves are sometimes "in the line of fire" when a surgeon is in the abdomen and pelvis.

That said, there are anatomical differences between people. That means the nerves are not always in the exact same place in each person. Even the most skilled surgeons could potentially sever a nerve by mistake.

Pelvic Nerve Structure Differences

Pelvic nerves are also in slightly different places or positions in each person. In some people, the nerves sit under the abdominal muscles. In other people, they pass right through them.

Some people also have more pelvic nerve branches than others. That means avoiding pelvic nerve damage during surgery is not always easy.

Stretched Nerves

Nerves do not always have to be cut or nicked to be damaged—stretching nerves can also hurt them.

Nerve Compression and Entrapment

Nerves can also get compressed after surgery. The nerves can get stuck between sutures, staples, or surgical mesh (nerve entrapment).

Nerves can also get trapped after surgery (cutaneous nerve entrapment). This happens when nerves near the surface of the abdomen become entrapped as they pass through the abdominal muscle.

Risk Factors

In the same way that the exact cause of SINP is unknown, it's not known which risk factors make a person more likely to have postoperative chronic nerve pain.

Some of the possible risk factors include:

• Having pain before surgery
• Psychological factors like anxiety
• How bad the pain was right after surgery

Diagnosis

A diagnosis of SINP is not always easy to make. In some cases, healthcare providers may not be able to pinpoint the cause of someone's pain.

The diagnosis can also be challenging because one person's experience of pain can be very different from another person's experience.

Providers can do a physical exam, use pain scale scoring, and order imaging tests to rule out other explanations for a person's pain. At that point, they would likely attribute the lasting pain to SINP.

Exam and Medical History

You will need to see your provider for an in-person office visit if you have post-surgery pain.

They will ask you questions about the type of pain you're having. They will ask you to describe how it feels—for example, you might say "like pins-and-needles," "stabbing," or "burning."

Pain Scale Scoring

To more objectively rate how much pain you are in, a provider can use a simple survey called a neuropathic pain scale (NPS).

The scale scores your pain symptoms on a scale of 0 to 10, where 0 is no pain and 10 is the worst pain you have ever felt.

Imaging

You may need to have imaging studies to look for nerve injuries. For example, computed tomography (CT) or magnetic resonance imaging (MRI) scans help your provider see inside different parts of your body more closely.

Newer imaging technologies are being developed to get a better images at the cellular and even molecular level.

Treatment

For chronic abdominal nerve pain that does not get better on its own following surgery, there are a few options for treatment.

Medications

Your provider may start by recommending that you try taking a medication for chronic neuropathic pain, such as:

• Tricyclic antidepressants
• Anticonvulsants such as Neurontin (gabapentin)
• Newer medications such as Lyrica (pregabalin)

These medications were not initially made for treating pain, but they have helped treat some pain conditions.

Nerve Blocks

Nerve blocks, or neural blockades, can help prevent or manage many different types of pain. They involve injections of medicines that block pain signals from specific nerves.

TENS

Transcutaneous electrical nerve stimulation (TENS) is a therapy that uses low-voltage electrical currents to provide pain relief.

A TENS unit is a battery-powered device that delivers electrical impulses through electrodes that are placed on the skin.

TENS has helped some people cope with intractable (treatment-resistant) nerve pain.

Surgery

In some cases, your provider may offer surgery as an option to reconnect severed nerves. There are a couple of different types of surgeries to repair nerves.

During a nerve repair, a surgeon removes the damaged section of nerve tissue and reattaches the healthy ends.

A nerve graft involves using nerve segments taken from another part of the body to repair damaged nerves.

Prevention

Acute postoperative pain is strongly linked with the risk for developing chronic pain. Good postoperative pain treatment is considered the best preventive strategy. That's why it's important that you tell your provider if you're in pain after surgery.

Studies have shown that aggressive, up-front pain management after surgery is linked to better pain control after.

Coping

Most studies suggest that the best nerve pain treatment is a combination of medications, medical therapies, and lifestyle measures. There are several things you can do to cope as you try to find the best management strategy for you.

Keep a Pain Journal

Writing about your experience can be very helpful when dealing with chronic pain.

Not only can it help you better understand your pain and give you a way to share your symptoms with your healthcare provider, but journaling can also be an effective way to figure out what works and what doesn't work in terms of managing your symptoms.

Explore Mind-Body Therapies

Mind-body therapies such as meditation, breathing exercises, and cognitive-behavioral therapy (CBT) can decrease your pain and decrease the stress in your life that make your pain worse.

Seek Support

Talking with others about your experiences can help relieve the stress of being in pain.

Being part of a chronic pain support group can provide you with the opportunity to ask questions, get referrals, or share your experiences with others who understand what you are going through.

Summary

Abdominal surgery can sometimes lead to chronic pelvic or abdominal pain. Usually, this is caused by severed, stretched, or compressed nerves.

Chronic nerve pain after surgery is sometimes called surgically-induced neuropathic pain (SINP).

The treatment for SINP can include medication, nerve blockers, TENS therapy, or surgical repair.

Acute post-surgical pain is strongly linked to chronic post-surgical pain. Therefore, the best prevention is to manage post-surgical pain as well as possible.

A Word From Verywell

If you're worried about an upcoming surgery causing you lasting pain, keep in mind that most people who have abdominal surgery do not develop chronic nerve pain.

More research is being done all the time. The results of these studies can give surgeons better techniques to use to avoid damaging nerves during procedures.

When you're considering or preparing for surgery, ask questions to make sure you are making an informed decision. If you don't feel you have all the information you need or you feel that your provider is not listening to your concerns, you might want to get a second opinion.