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Scar Tissue Pain

Management of scar tissue pain has evolved as an essential field of science over the past years as scars can negatively impact one’s quality of life. Scarring can lead to significant pain, tenderness, itchiness, and functional limitations for the patient, which may last for many years. (1) In this article we describe the best treatment options available.

What is a Scar Tissue?

Scar Tissues are formed by the accumulation of cells and collagen fibers that help cover the injured area. The common reason for the development of scar tissue includes an injury or trauma, surgical procedure, or acne. However, the scar tissue is limited to the skin surface and may also affect the internal structures, such as scar tissue formed in the heart during a myocardial infarction. (2)

Scar Tissue may not always be associated with pain, particularly in the early stages. This is because, during the early stages, the nerves are not disrupted. But as time goes on and healing processes continue, scar tissues may become painful. Again, this is due to the involvement of nerve endings.

What is Scar Tissue Pain?

Scar Tissue Pain may vary from individual to individual. While it may be more apparent in some individuals immediately after the formation of the scar, others may start experiencing it much later in life. Some individuals may even start experiencing pain after the complete healing of the scars due to later involvement of nerves. Another major cause of scar tissue pain is the damage caused by deep wounds and burns to the bones and joints underneath. This may present as a ‘deeply’ felt pain at the scarring sites.

In the cases of internal injuries and trauma, scar tissues may replace the healthy tissues inside. As the scarring worsens and time goes on, the pain and discomfort felt by the individual may also worsen. An example of this is the scar tissue formation seen in the lungs in conditions like Pulmonary fibrosis. Individuals with Pulmonary fibrosis often experience painful cough, fatigue, and joint aches.

Types of Scars

Scar tissues may present in different forms inside the body. These include Keloid Scars, Hypertrophic Scars, Pitted Scars, Contracture Scars, Adhesion Scars, and Stretch Marks.

Keloid Scars tissue pain

The overproduction of collagen forms keloid Scars at the site of the wound. It is characterized by an overgrowth of scar tissue, even after the wound has healed. Keloid scars are often associated with enlarged blood vessels. (3)

Hypertrophic Scars

Hypertrophic Scars are similar to Keloid Scars in that they involve an excessive collagen buildup at the wound site. However, what makes them unique is that hypertrophic scars never extend outside the original boundary of the wound.

Pitted Scar tissue pain

Pitted Scars present with a sunken or indurated appearance and may after conditions like Acne and Chickenpox.

Contracture Scars

Contracture Scars are commonly seen in association with burn injuries. Due to the contraction of the tissue, they may also disrupt the movement in the affected area. (4)

Adhesion Scars

Adhesion Scars are characterized by the formation of bands of scar inside the body, which is commonly seen after surgery. A common example of Adhesion scars is abdominal adhesions, which may present with bloating, nausea, and abdominal and back pain.

Stretch Marks

Stretch Marks, also known as Striae, are indented streaks on the skin surface. These may be seen on the abdomen, breast, hips, and other parts of the body. Stretch marks are commonly seen in pregnant females during the last trimester of pregnancy. (5)

What Are the Symptoms of Scar Tissue Pain?

Scar Tissues usually present a thicker and rougher texture than the rest of the skin and body surfaces. The common symptoms associated with Scar Tissues include:

  • Swelling
  • Redness
  • Itching
  • Sensitivity to touch
  • limited range of motion
  • Throbbing sensation

While most scar tissues may be visible, those formed inside the body surfaces due to internal wounds, surgeries, and medical conditions may not be as apparent to the eye. Instead, the individual may experience stiffness and pain at these internal scarring sites, especially if it affects a joint.

How is Scar Tissue Pain Diagnosed?

Scar Tissue diagnosis includes detailed history and evaluation of the scar site. During history taking and examination, the factors which may be considered include:

  • The anatomical location of the scar on the body
  • The appearance of the scar – this includes the surface, color, texture, and margins (6)
  • The symptoms experienced by the patient
  • The functional imparity caused by the scarring
  • How is the scar may be affecting the patient social life and mental health

Even though the majority of scars are visible to the naked eye, they may also need to be assessed via tools like Vancouver Scar Scale and Manchester Scar Performa. (7)

What Are The Treatment Options For Scar Tissue Pain?

The recommended treatment plan by a healthcare professional for the treatment of Scar Tissues and associated plans may include conservatives methods, invasive treatment, and home treatments.

Reconstructive and Revision Surgery

Scar Tissue may be treated using reconstruction and revision surgeries. These may include techniques like excision and skin grafting. These are often recommended for individuals who have a high degree of aesthetic concern along with the painful symptoms caused by the scars. This is common in individuals with third-degree burns, deep wounds from traumas, and other injuries. Even though this is effective at removing the present scars, there is always a risk for additional scarring in response to the surgery, known as keloid scars. Hence, it is important to consult an experienced and trained plastic surgeon to determine the best treatment option for the individual.

Dermatologic Techniques

Dermatological procedures like dermabrasion and laser therapies may be effective for the treatment of scars caused by burns, acne, and lacerations. (8)

However, these dermatological procedures often require multiple treatment sessions of the individual may be able to see their desired results. Moreover, topical therapies associated with the dermatological procedure may also be effective as they help remove the outer layers of the scar tissues effectively. However, a disadvantage of the dermatological procedure is that it may make the scarring more visible for a temporary period right after the treatment. It may also be associated with mild pain and swelling.

Topical Serums

Topical medications and serum may also be used for the superficial treatment of scar tissue. These often contain high levels of Vitamin C and other antioxidants. These topical serums may diminish the appearance of slight or moderate scarring over time; however, they are not as effective for deeper scars. Some of these serums may also be given in conjunction with antihistamine creams to treat the symptoms of itchiness and irritation at the scar tissue site.

Corticosteroid and Botox Injections

Corticosteroid injections may be taken as a treatment option for keloid and hypertrophic scarring. However, these injections can only be taken after medical advice and administered by a trained professional. (9)

The other type of injection which may be administered to patients with scarring is Botox Injections. These work by relaxing the muscles and lowering the discomfort and pain of the patient. However, these may only help with the chronic pain associated with scarring and not the scar itself.

Silicone Adhesion Barriers

Silicone gels may be used as a preventative treatment for the adhesion scarring formed after surgery. These are available in the form of bandages that are applied to the body to prevent surgical scars and stick together tissues as seen after surgery.

These can also help prevent the adhesion scarring after gynecological procedures like C section and Hysterectomy.

Tissue Massage

Massages are proven to be an effective scar pain-relieving remedy for different types of scars. This is because massage helps achieve deep tissue mobilization and myofascial release, which cause reduction of inflammation and promote movement of the affected area. A massage therapist or a chiropractor usually gives these.

The Graston Technique

Graston Technique is an effective joint treatment, which health professionals may often recommend for the treatment of scar tissue pain. This technique helps improve the overall range of motion of the affected site, which helps break up the scar tissue. This is particularly effective for individuals with scar tissue in their joints. (10)

Physical Therapy

Physical Therapy is an effective treatment and management for individuals with altered function of muscles and joints due to deep scarring from injuries and burns. This may present as a limited range of motion and the inability of the individual to carry out their everyday tasks. The physical therapist may recommend a number of exercises that can help strengthen the joints and muscles in order to improve body mobility. The areas most commonly targeted by Physical Therapy include the back, abdomen, and limbs.

At-Home Treatments

The Physical therapist may recommend some exercises and stretches’ which may be carried out at home. These stretches should be specially conducted during the morning time, as this is when the body is at its stiffest. The patients may also use natural products like Blackseed oil, rosehip seed oil, honey, and aloe Vera, as they help reduce the inflammation and irritation at the scarring site.

Prolotherapy

Scar tissue has a poor blood supply, so it can struggle to heal independently. It is the oxygen and nutrients in our blood supply that helps to heal scar tissue pain.

Prolotherapy involves injecting a natural regenerative solution into scar tissue to provide a direct supply of what is needed to heal it and relieve pain.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

References:

  1. Bock, O., Schmid-Ott, G., Malewski, P., & Mrowietz, U. (2006). Quality of life of patients with keloid and hypertrophic scarring. Archives of dermatological research, 297(10), 433–438. https://doi.org/10.1007/s00403-006-0651-7
  2. Corr DT, Hart DA. Biomechanics of Scar Tissue and Uninjured Skin. Adv Wound Care (New Rochelle). 2013;2(2):37-43. doi:10.1089/wound.2011.0321
  3. Betarbet U, Blalock TW. Keloids: A Review of Etiology, Prevention, and Treatment. J Clin Aesthet Dermatol. 2020;13(2):33-43.
  4. Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ. 2003;326(7380):88-92. doi:10.1136/bmj.326.7380.88
  5. Oakley AM, Patel BC. Stretch Marks. [Updated 2021 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK436005/
  6. Beausang, E., Floyd, H., Dunn, K. W., Orton, C. I., & Ferguson, M. W. (1998). A new quantitative scale for clinical scar assessment. Plastic and reconstructive surgery, 102(6), 1954–1961. https://doi.org/10.1097/00006534-199811000-00022
  7. Powers, P. S., Sarkar, S., Goldgof, D. B., Cruse, C. W., & Tsap, L. V. (1999). Scar assessment: current problems and future solutions. The Journal of burn care & rehabilitation, 20(1 Pt 1), 54–53. https://doi.org/10.1097/00004630-199901001-00011
  8. Alster, T. S., & Williams, C. M. (1995). Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet (London, England), 345(8959), 1198–1200. https://doi.org/10.1016/s0140-6736(95)91989-9
  9. Niessen, F. B., Spauwen, P. H., Schalkwijk, J., & Kon, M. (1999). On the nature of hypertrophic scars and keloids: a review. Plastic and reconstructive surgery, 104(5), 1435–1458. https://doi.org/10.1097/00006534-199910000-00031
  10. Lee JH, Lee DK, Oh JS. The effect of Graston technique on the pain and range of motion in patients with chronic low back pain. J Phys Ther Sci. 2016;28(6):1852-1855. doi:10.1589/jpts.28.1852

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