Conditions Evaluated
Persistent Pain After
Injury or Surgery.
Pain that continues beyond the expected period of recovery from an injury or surgical procedure is a recognized clinical presentation. It can arise from a variety of mechanisms and often benefits from a thorough re-evaluation to identify which factors are currently driving the pain.
In Brief
Pain Beyond Expected Healing
It is recognized that pain can persist long after a tissue injury has healed or a surgical procedure has been completed. This is not uncommon and has multiple possible contributing mechanisms.
Multiple Contributing Factors
Persistent pain after injury or surgery may involve nerve irritation, altered movement patterns, scar tissue sensitivity, residual structural contributors, or changes in pain processing — often in combination.
Re-evaluation Is Important
Rather than assuming the original diagnosis remains unchanged, a careful clinical re-evaluation aims to identify the current pain generators and contributors to guide a rational treatment approach.
Overview
Why Pain Can Persist After Injury or Surgery.
Healing after an injury or surgery involves a complex biological process, and tissue repair does not always mean the resolution of pain. A number of mechanisms can contribute to pain that persists or develops beyond the expected recovery period.
Nerve irritation or injury may occur during the original event or as part of the surgical procedure — producing neuropathic pain in the affected area. Scar tissue formation can alter the mechanical environment, compress adjacent structures, or create areas of focal sensitivity. Changes in movement patterns that develop after an injury can place increased stress on nearby joints, muscles, or the spine.
In some cases, changes in how the nervous system processes pain — sometimes called central sensitization — can amplify pain signals over time, making the experience of pain more intense or more widespread than the local tissue findings alone would suggest. Identifying which of these mechanisms is contributing is an important part of the clinical evaluation.
Contributors
Possible Contributing Factors.
Each patient's situation is different. Among the factors that may contribute to persistent pain after injury or surgery are:
- Peripheral nerve irritation or injury at the site of trauma or surgical dissection
- Scar tissue sensitivity or nerve entrapment within scar formation
- Residual or new structural pathology — such as joint degeneration, disc changes, or ligament involvement — adjacent to the original injury or surgical site
- Altered biomechanics and movement patterns that develop secondary to the original injury
- Myofascial contributors — including muscle guarding, trigger points, and postural changes that persist after the primary injury has resolved
- Central sensitization, in which the nervous system develops an amplified response to pain signals over time
- Incomplete resolution of the original diagnosis, or an overlapping condition that was not identified at the time of the initial injury or surgery
Approach
How Dr. Dardashti Approaches This Evaluation.
Evaluation begins with a thorough review of the prior injury or surgery, the original diagnosis, treatment received, and the timeline of pain relative to recovery. Relevant operative records, imaging, and prior treatment notes are reviewed when available.
The current pain is assessed carefully — its location, character, distribution, and relationship to activity and posture — to identify whether it reflects the same mechanism as the original complaint or suggests new or overlapping contributors. A physical and neurologic examination assesses the current clinical picture independent of prior diagnoses.
This re-evaluation process is not about questioning prior care. Its purpose is to understand the current pain generators as clearly as possible, so that a rational and individualized treatment plan can be developed.
Treatment
Treatment Options That May Be Considered.
Treatment depends on the identified contributors and the patient's prior treatment history. Options that may be considered include:
- Physical therapy and movement rehabilitation to address altered biomechanics
- Medication management targeting the specific mechanism of persistent pain
- Targeted nerve blocks or joint injections when a focal peripheral contributor is identified
- Trigger point injections when myofascial pain is a significant contributor
- Neuromodulation evaluation — such as spinal cord stimulation — for selected patients with refractory neuropathic or mixed pain
- Multimodal pain management planning that addresses the full range of contributing factors
Treatment recommendations are individualized based on the clinical evaluation. Not every patient requires an interventional procedure.
Limitations
Important Limitations.
Persistent pain after injury or surgery is a complex clinical problem. Multiple contributing factors are often present simultaneously, and identifying all of them with certainty is not always possible. Response to treatment is variable and depends on the specific mechanisms involved.
A formal clinical evaluation is required to determine the appropriate approach for any individual patient. This page is for general informational purposes only and does not constitute medical advice or create a physician-patient relationship.
Dr. Dardashti sees patients in Mission Hills, California, serving patients from the San Fernando Valley, Santa Clarita Valley, and surrounding Los Angeles communities.