Post-Surgical Pain

Post-surgical pain refers to the pain experienced after a surgical procedure. It is the body’s natural response to tissue injury and typically occurs as part of the healing process. Depending on the type of surgery, this pain can vary in location, intensity, and duration, ranging from mild discomfort to more severe and persistent symptoms.

The nature of post-surgical pain is influenced by several factors. These include the surgical site, the extent of tissue trauma, whether nerves were affected during the operation, the individual’s overall health, pain threshold and previous pain experiences. For most patients, this pain is temporary and improves steadily in the days or weeks following surgery. However, in some cases, it may persist for longer than expected, developing into a condition known as chronic post-surgical pain.

How does pain present after surgery?

Post-surgical pain can present in several different forms, depending on the type of procedure, the areas involved, and individual factors such as age, underlying health conditions, and previous pain experiences.

Types of Post-Surgical Pain

While post-surgical pain is commonly categorised based on duration — acute, subacute, and chronic — other types such as neuropathic and referred pain may also occur, particularly when nerves are involved or pain radiates beyond the site of surgery. Each type has distinct characteristics and implications for recovery.

Acute post-surgical pain — occurs immediately after surgery and typically lasts for a few days to weeks. This is the most common form of post-surgical pain and is usually localised to the site of the operation. It results from tissue damage caused during the procedure and is part of the body’s natural inflammatory response. The intensity of acute pain often peaks within the first 24 to 72 hours and gradually decreases as healing progresses. Proper management of acute pain is essential not only for comfort but also to allow early mobilisation, reduce complications, and lower the risk of it developing into chronic pain.
Subacute post-surgical pain — refers to pain that continues beyond the initial recovery period, typically up to three months after surgery. At this stage, the surgical wound may appear healed on the surface, but deeper tissues are still recovering. Subacute pain may persist due to ongoing inflammation, irritation of healing structures, or delayed tissue repair. Patients may experience intermittent or activity-related discomfort, which generally improves with time and appropriate rehabilitation.
Chronic post-surgical pain (CPSP) — defined as pain that lasts for more than three months after surgery, without any clear ongoing cause such as infection or structural abnormality. CPSP is a recognised medical condition and may arise from nerve injury during surgery, abnormal healing responses, or central sensitisation — where the nervous system becomes more sensitive to pain signals. This type of pain can be dull, burning, shooting, or stabbing in nature, and may be accompanied by numbness or tingling. CPSP can significantly affect quality of life, limiting mobility, work, sleep, and emotional well-being.
Neuropathic post-surgical pain — may occur when nerves are damaged during surgery. This pain often presents as burning, shooting, or electric shock-like sensations, and may not respond well to standard painkillers. It can coexist with other types of pain and is more common in procedures involving nerve-rich areas, such as breast, thoracic, or orthopaedic surgeries.
Referred pain — sometimes patients report pain in areas distant from the surgical site. This occurs due to the way nerves transmit pain signals, leading to discomfort that appears unrelated to the original site of trauma. An example would be shoulder tip pain following abdominal or laparoscopic procedures due to diaphragmatic irritation.

What causes post-surgical pain?

Post-surgical pain arises from a combination of physical, neurological, and inflammatory responses triggered by surgical intervention. While pain is a normal and expected part of recovery, its intensity and duration can vary widely depending on several contributing factors.

Tissue injury — surgical procedures involve cutting through skin, muscles, ligaments, and other tissues. This mechanical disruption activates pain receptors (nociceptors) in the affected area, which send signals to the brain. The extent of tissue damage directly influences the severity of pain. Larger or more invasive procedures typically lead to more pronounced pain.
Inflammatory response — after surgery, the body initiates an inflammatory process to promote healing. While this response is essential for tissue repair, it can also lead to swelling, redness, and increased sensitivity in the operated area. Inflammatory mediators such as prostaglandins and cytokines amplify pain signals, which make the affected tissues more sensitive to movement or touch.
Nerve irritation or injury — some surgical procedures may involve stretching, compressing, or cutting nerves. When nerves are damaged, they may send abnormal pain signals or become overly sensitive. This can result in neuropathic pain — a type of post-surgical pain that is often described as burning, tingling, or electric shock-like. Nerve pain may appear immediately after surgery or develop gradually during the healing process.
Muscle spasms and tension — surgical manipulation, especially in orthopaedic or abdominal procedures, can lead to localised muscle stiffness or spasms. These involuntary contractions can cause additional pain and discomfort, particularly when trying to move or change position.
Complications during healing — pain may also result from postoperative complications such as infection, haematoma (collection of blood), seroma (collection of fluid), or poor wound healing. These issues can prolong inflammation, increase pressure in the tissues, and delay recovery, all of which contribute to persistent or worsening pain.
Pre-existing pain conditions — individuals who have chronic pain syndromes, such as arthritis, fibromyalgia, or previous surgical pain, may experience heightened sensitivity to postoperative pain. This is partly due to changes in how their nervous system processes pain and may require a more tailored approach to pain control.
Psychological factors — stress, anxiety, and fear can intensify the perception of pain.

Patients who are anxious before surgery or have a history of depression may report higher pain levels, as emotional states influence how the brain interprets pain signals.

In most cases, post-surgical pain is a temporary and manageable part of recovery. However, when multiple factors interact, such as significant tissue trauma combined with nerve involvement or delayed healing, the pain may become more complex and require specialised management.

What are the symptoms of post-surgical pain?

Post-surgical pain can present in different ways depending on the type of surgery, area affected, and the individual’s overall health. Recognising common symptoms can help identify whether the pain is following a typical recovery course or requires further attention.

Localised pain — discomfort is usually felt at or near the surgical site and may be described as sharp, aching, throbbing, or burning. The pain may worsen with movement, coughing, or deep breathing.
Swelling and tenderness — mild swelling and sensitivity around the wound are common during healing. However, excessive or increasing swelling may point to complications such as fluid build-up or infection.
Radiating or referred pain — pain may extend to surrounding areas or distant regions (e.g. shoulder tip pain after abdominal surgery) due to nerve pathways or diaphragmatic irritation.
Tingling or numbness — altered sensations like pins and needles, burning, or loss of feeling may occur when nearby nerves are affected during surgery.
Movement-related stiffness — pain can limit mobility, leading to stiffness in the muscles or joints near the operated site, especially during early recovery.
Increased sensitivity — the operated area may become hypersensitive to touch, pressure, or temperature due to inflammation or nerve involvement.
Sleep disturbance and fatigue — ongoing pain can interfere with rest and recovery, leading to tiredness, irritability, or low mood, particularly if it persists longer than expected.

If post-surgical pain does not gradually improve or starts to worsen over time, it is important to seek medical review to rule out complications or the development of chronic pain.

Who is at risk of experiencing post-surgical pain?

While post-surgical pain is common, some individuals are more likely to experience severe, prolonged, or chronic pain after surgery. Various patient-related and procedure-related factors can increase this risk.

Type and extent of surgery — major operations, procedures involving large incisions, or those that affect nerve-dense areas (such as thoracic, breast, or orthopaedic surgeries) tend to cause more intense and prolonged pain.
History of chronic pain — individuals who already live with conditions like arthritis, fibromyalgia, or back pain may be more sensitive to post-surgical pain and may require more intensive pain management.
Preoperative anxiety or depression — emotional health significantly affects pain perception. High stress levels, anxiety, or untreated depression before surgery can heighten postoperative pain responses.
Younger age — younger patients, particularly those under 60, are more likely to report higher pain scores after surgery, possibly due to greater nerve sensitivity or heightened pain awareness.
Female sex — studies suggest that women may experience more postoperative pain than men, potentially due to hormonal, psychological, and biological differences in pain processing.
Smoking and poor physical health — smokers and individuals with underlying medical conditions (such as obesity or diabetes) may have slower healing and more postoperative complications, which may increase the likelihood of persistent pain.
Previous surgical trauma — patients who have experienced difficult recoveries or chronic pain following past surgeries may be more prone to develop pain after future procedures.
Genetic and physiological differences — some individuals may have a lower pain threshold or different pain processing mechanisms, which makes them more susceptible to prolonged or severe postoperative pain.

How can I prevent post-surgical pain?

While some level of pain is expected after surgery, there are several ways to minimise its intensity, reduce the risk of complications, and prevent it from becoming persistent or chronic. Prevention begins before the surgery itself and continues throughout the recovery period.

Preoperative planning — a thorough assessment before surgery allows the healthcare team to identify any risk factors for increased or prolonged pain, such as existing chronic pain conditions, anxiety, or previous difficult recoveries. Based on this, a tailored pain management plan can be put in place.

Use of preventive (pre-emptive) analgesia — pain relief is often started before surgery or administered during the operation to block pain signals from the outset. Techniques may include regional nerve blocks, spinal or epidural anaesthesia, or intravenous medications.

Consistent pain control after surgery — taking medications as prescribed, without waiting for pain to become severe, helps maintain steady pain relief and prevents pain from becoming more difficult to control. Skipping or delaying doses can allow pain to escalate and make it harder to manage.

Early mobilisation and physiotherapy — moving as soon as it is safe to do so helps prevent stiffness, improves circulation, and reduces the risk of complications like blood clots, all of which can contribute to less pain during recovery.

Wound care and infection prevention — keeping the surgical site clean and monitoring for signs of infection or delayed healing can prevent complications that would otherwise prolong pain.
Psychological preparation and support — managing anxiety before surgery and having realistic expectations about recovery can influence how pain is perceived and tolerated. Support from the care team, family, or counselling services may help reduce emotional distress, which is often linked to increased pain sensitivity.

What is a post-surgical pain assessment?

A post-surgical pain assessment is a structured process used to evaluate the nature, severity, and impact of a patient’s pain following surgery. It helps guide treatment decisions and ensures that pain management strategies are working effectively.

Pain intensity scoring — patients are often asked to rate their pain using a standard scale, such as the Numeric Rating Scale (0–10) or a Visual Analogue Scale. This helps track changes in pain levels over time.
Description of pain — patients may be asked to describe how the pain feels — for example, sharp, dull, throbbing, burning, or shooting. These descriptions help identify whether the pain is inflammatory, mechanical, or nerve-related.

Pain location and pattern — noting where the pain is felt and whether it spreads or changes with movement provides insight into possible complications or nerve involvement.

Impact on function — the assessment includes understanding how pain affects mobility, breathing, sleep, appetite, or mood. This helps determine whether pain is interfering with recovery.

Response to pain relief — monitoring how well pain responds to medication or other therapies allows adjustments to the treatment plan if needed.

Frequency of assessments — pain is assessed regularly, especially in the first few hours and days after surgery. This ensures that any breakthrough pain or new symptoms are promptly addressed.

A thorough pain assessment is a key part of post-operative care. It not only improves patient comfort but also helps prevent complications and supports a smoother recovery.

How is post-surgical pain treated?

Treating post-surgical pain effectively is essential to support recovery, improve mobility, and prevent complications such as chronic pain. Management typically involves a tailored, multimodal approach — combining medications, regional anaesthesia techniques, and non-drug therapies to target different pain pathways.

Oral pain medications — common first-line options include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). These help reduce inflammation and relieve mild to moderate pain.
Opioid analgesics — medications such as morphine or oxycodone may be prescribed for short-term relief of severe pain, particularly in the first few days after major surgery. They are used cautiously due to risks of side effects and dependence.
Regional anaesthesia — techniques like epidural analgesia or peripheral nerve blocks can provide targeted pain relief during and after surgery, often reducing the need for opioids.
Patient-controlled analgesia (PCA) — allows patients to self-administer a controlled dose of pain medication via a pump, which provides timely relief and reduces the likelihood of under-treatment.
Local anaesthetic infiltration — in some cases, anaesthetists may insert a catheter to deliver continuous local anaesthetic directly into the surgical site over several days.
Adjuvant medications — drugs such as gabapentin, pregabalin, or antidepressants may be used to treat nerve-related or persistent pain that does not respond to standard analgesics.
Physical therapy — guided movement and rehabilitation can help reduce stiffness, improve circulation, and promote healing, especially in joint or muscle-related surgeries.
Complementary therapies — techniques like cold or heat application, relaxation exercises, acupuncture, or transcutaneous electrical nerve stimulation (TENS) may be used as supportive measures.

The goal of treatment is not to eliminate all pain, but to reduce it to a manageable level that allows rest, movement, and healing. Pain management plans are adjusted over time based on how the patient is responding and whether symptoms are resolving as expected.

Summary

Post-surgical pain arises as a natural response to tissue injury during surgery and can vary in intensity, duration, and presentation. While most patients experience acute pain that improves with healing, some may develop prolonged or nerve-related pain that requires closer attention. Factors such as the type of surgery, existing health conditions and emotional well-being can influence the severity and persistence of pain.

If you are scheduled for surgery or experiencing ongoing discomfort after a procedure, schedule a consultation with us for tailored pain relief and comprehensive post-operative care.