An Overview of Abdominal Pain After Surgery

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On occasion, abdominal surgery can sometimes lead to chronic abdominal nerve pain or chronic pelvic nerve pain. Sometimes, during an appendectomy, gynecological surgery, or hernia repair, abdominal or pelvic nerves are cut, stretched, or otherwise damaged. This complication—referred to as surgically-induced neuropathic pain (SINP)—may be distressing and debilitating.

A women with abdominal pain
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It is unclear how often this occurs, but researchers are starting to learn that nerve pain following surgery is much more common than once thought.

Some studies have suggested that up to 30% of common abdominal surgeries, such as hysterectomies and hernia repairs, result in some level of chronic nerve pain.

These statistics can be concerning to read if you are planning to have surgery, but you may be able to do things to reduce the risk. At the same time, researchers are looking at ways to reduce the risk of SINP and effectively treat it if it does occur.

This article explains post-surgical abdominal pain causes, diagnosis, and treatment.

Causes of Post-surgical Abdominal Pain

Abdominal surgery has been known on occasion to cause damage to the ilioinguinal, iliohypogastric, or genitofemoral nerves—each of which can cause postoperative pelvic nerve pain.

What Are Border Nerves?

The ilioinguinal, iliohypogastric, and genitofemoral nerves are sometimes referred to as "border nerves" because they supply sensation to the skin bordering the thighs and abdomen.

With that said, there is not always a simple relationship between nerve damage and SINP. There are a variety of reasons why SINP occurs.

Severed Nerves

During routine abdominal and pelvic surgeries, the iliohypogastric and ilioinguinal nerves are often directly in the line of fire. Due to anatomical differences between people, even the most skilled surgeons have the potential to sever these nerves.

Pelvic Nerve Structure Varies

Anatomically, pelvic nerves are different in each person. In some people, the nerves sit under the abdominal muscles. In other people, they may pass right through them.

Some people have more pelvic nerve branches than others. Therefore, avoiding pelvic nerve damage during surgery is not easy when there are many potential variations.

Stretched Nerves

Stretching pelvic nerves can also cause damage. You don’t have to have your pelvic nerves cut or nicked to suffer from chronic pelvic nerve pain. Sometimes, the nerves are stretched enough during surgery that they are damaged.

Nerve Compression

Pelvic nerves may become compressed after surgery. In addition, nerve entrapment—in sutures, staples, or surgical mesh—can also lead to SINP during abdominal or pelvic surgery.

Nerve Entrapment

Pelvic nerves can become entrapped following surgery. After surgery, a significant but under-recognized cause of chronic abdominal pain is cutaneous nerve entrapment.

Entrapment occurs when nerves near the surface of the abdomen become entrapped as they pass through the rectus (abdominal) muscle. Nerve entrapment is thought to be the cause of around 30% of cases of SINP after abdominal surgery.

Recap

Post-surgical abdominal pain usually involves some nerve damage. Sometimes during surgery, nerves are cut, stretched, or compressed. Avoiding damaging nerves during surgery is not always easy since everyone's nerve structures are different.

Risk Factors

In the same way that the exact cause of SINP can be unknown, it isn't clear what risk factors predispose a person to postoperative chronic nerve pain. Suspected risk factors include:

  • Preoperative pain
  • Psychological factors (such as extreme anxiety)
  • Intensity of immediate postoperative pain

The most common predictor of SINP is the severity of acute pain immediately following surgery. The greater the severity, the greater the risk of SINP.

Diagnosis

The diagnosis of SINP is not always easy, and, in some cases, healthcare providers may not be able to pinpoint the cause. It can also be challenging because one person's experience of pain is often very different from another person's experience.

Diagnosis usually involves a physical exam, pain scale scoring, and imaging tests.

Exam and Medical History

The diagnosis typically involves an in-office evaluation. A healthcare provider will ask you a series of questions to better characterize the type of pain (e.g., pins-and-needles, stabbing, burning).

Pain Scale Scoring

To more objectively establish the level of pain a person is experiencing, a simple survey called a neuropathic pain scale (NPS), which scores symptoms on a scale of 0 to 10, can help.

Imaging

In addition, you may need imaging studies to check for nerve injury, including computed tomography (CT) or magnetic resonance imaging (MRI) scans. Newer imaging technologies are being developed to evaluate cellular and even molecular nerves.

In cases of compression or entrapment, a healthcare provider can diagnose your condition by injecting a local anesthetic near the site of the suspected nerve injury (which they can visualize via ultrasound). Any resolution of the pain following the injection can help healthcare providers pinpoint the nerve to treat.

Treatment

There are several possible treatments for chronic abdominal nerve pain that doesn't resolve on its own following surgery.

Medications

Most healthcare providers will recommend certain medications for chronic neuropathic pain. The most commonly prescribed drugs include:

Newer medications such as Lyrica (pregabalin) have also been effective for some people. Although these medications weren't initially developed for treating pain, they have relieved pain in some conditions.

It is important to note that antidepressants prescribed for chronic pain modulate pain receptors in the brain. In other words, healthcare providers do not prescribe these drugs because they believe "your pain is in your head."

Nerve Blocks

Nerve blocks, or neural blockades, are procedures that can help prevent or manage many different types of pain. They often 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 placed on the skin. TENS has helped some people cope with intractable (treatment-resistant) nerve pain.

Surgery

In specific cases, your healthcare provider may explore 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.

On the other hand, a nerve graft involves implanting nerve parts from another part of the body where the damage occurred.

Recap

There are several treatment options for post-surgical nerve pain. They include medication, nerve blockers, TENS, and surgical repair.

Prevention

Researchers have a long way to go in determining the best ways to prevent SINP. However, since acute postoperative pain is strongly linked with the risk for chronic pain, aggressive postoperative pain treatment is considered the best preventative strategy.

Studies have shown that aggressive, up-front pain management following surgery corresponds to better pain control down the line.

In other words, you need to inform your healthcare provider of any pain you experience after surgery and not dismiss it as something you'll "get over."

Before undergoing surgery, talk to your surgeon about how much pain is expected after surgery.

Coping

Most studies suggest that the best nerve pain treatment is a combination of medications, medical therapies, and lifestyle measures. However, there are several things you can do to cope as you explore the most effective means of treatment.

Keep a Pain Journal

Chronicling your experience can be very helpful when dealing with chronic pain. Not only could it help you further understand your pain so that you can share your symptoms with your healthcare provider, but it can also be an effective way to determine what works and what doesn't work in managing your symptoms.

Explore Mind-body Therapies

From meditation to yoga, mind-body therapies can decrease your pain and decrease the stress in your life that exacerbates your pain.

Seek Support

Talking with others about your experiences often helps relieve the stress of suffering in silence. Working with a chronic pain support group also provides you the means to ask questions, seek referrals, or share experiences with others who fully understand what you are going through.

Summary

Abdominal surgery can sometimes result in chronic pelvic or abdominal pain. Usually, this is caused by severed, stretched, or compressed nerves. Treatment may include medication, nerve blockers, TENS therapy, or surgical repair. Since acute post-surgical pain is strongly linked to chronic post-surgical pain, the best prevention is to manage post-surgical pain aggressively.

A Word From Verywell

If you are concerned about pain as you approach a scheduled surgery, keep in mind that most people who undergo abdominal surgery do not experience SINP.

As more and more research becomes available, surgeons utilize more advanced techniques to avoid damage to pelvic nerves during abdominal and pelvic surgery. To make an informed choice about a surgical procedure, ask as many questions as possible and seek a second opinion if needed.

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