Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review

Abd‐Elsayed, Alaa; Pope, Jason E.; Mundey, Derick A.; Slavin, Konstantin V.; Falowski, Steven; Chitneni, Ahish; Popielarski, Stephen R.; John, Jarod; Grodofsky, Samuel; Vanetesse, Tony; Fishman, Michael; Kim, Philip

doi:10.2147/jpr.s355096

Cited by 16 publications

(12 citation statements)

References 106 publications

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“…[12] In VAS scores, patients in the general anesthesia group had less pain on a postoperative day than those in the surface anesthesia group, and one study found that intraoperative administration of intravenous anesthetic medication for analgesia reduced the incidence of chronic postoperative pain, which is consistent with the results of this study. [15] Brendan et al found that only 25% of patients with hypertrophic scars who underwent laser treatment under general anesthesia experienced postoperative pain, and general anesthesia was the ideal choice.…”

Section: Discussionmentioning

confidence: 99%

Effect of general and surface anesthesia on micro-plasma radiofrequency of hypertrophic scar: A retrospective cohort study

Meng

Qian

et al. 2023

Preprint

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Background Although micro-plasma radiofrequency (MPR) treatment has a significant effect on scars, patients require anesthesia to relieve the significant discomfort it produces. Whether anesthesia impacts efficacy is unclear. Objective To evaluate the effect of different anesthesia on MPR for hypertrophic scars. Methods A retrospective cohort study involving 101 people was conducted to investigate the effectiveness and safety of general and topical anesthetics for the treatment of MPR scars. The primary measures of outcome were the Vancouver Scar Scale (VSS) scores before the first treatment and six months after the last treatment, as well as the Visual Analogue Scale (VAS) scores on the day and the day after the final treatment. Results The differences in scar pigmentation, vascularity, and overall VSS scores were higher in the general anesthesia group than in the surface anesthesia group. Patients in the general anesthesia group had a lower pain level than those in the surface anesthesia group. After adjusting for confounding factors and propensity score matching, the outcome of VSS and VAS scores was stable. There was no statistical difference in the adverse effects and satisfaction between the two groups. Conclusion General anesthesia, as opposed to surface anesthesia, may not only ensure safety but also increase the effectiveness of MPR and lessen postoperative pain in the treatment of hypertrophic scars.

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Section: Discussionmentioning

confidence: 99%

Effect of general and surface anesthesia on micro-plasma radiofrequency of hypertrophic scar: A retrospective cohort study

Meng

Qian

et al. 2023

Preprint

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“…Pelvic pain and dyspareunia are two of the most difficult clinical problems to assess and treat 36 . Painful scars can occur after all types of surgery, and the scar tissue extends below the skin and crosses tissue planes, creating an opportunity for nerve injury or entrapment 37 . As suggested by Steege et al, obstetricians and gynecologists may benefit from learning from the literature of other specialties that deal with pain related to surgical scars 36 .…”

Section: Discussionmentioning

confidence: 99%

“…37 As suggested by Steege et al, obstetricians and gynecologists may benefit from learning from the literature of other specialties that deal with pain related to surgical scars 36. …”

mentioning

confidence: 99%

Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia

Huber

Larsson

Lehmann

et al. 2023

Acta Obstet Gynecol Scand

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IntroductionPelvic floor pain and dyspareunia are both important entities of postpartum pelvic pain, often concomitant and associated with perineal tears during vaginal delivery. The association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia has not been fully established. We aimed to determine the prevalence of postpartum anal sphincter defects using three‐dimensional endoanal ultrasonography (3D‐EAUS) and evaluate their association with symptoms of pelvic floor pain and dyspareunia.Material and methodsThis prospective cohort study followed 239 primiparas from birth to 12 months post delivery. Anal sphincters were assessed with 3D‐EAUS 3 months postpartum, and self‐reported pelvic floor function data were obtained using a web‐based questionnaire distributed 1 year after delivery. Descriptive statistics were compared between the patients with and without sonographic defects, and the association between sonographic sphincter defects and outcomes were analyzed using logistic regression.ResultsAt 3 months postpartum, 48/239 (20%) patients had anal sphincter defects on 3D‐EAUS, of which 43 (18%) were not clinically diagnosed with obstetric anal sphincter injury at the time of delivery. Patients with sonographic defects had higher fetal weight than those without defects, and a perineum <2 cm before the suture was a risk factor for defects (odds ratio [OR], 6.9). Patients with sonographic defects had a higher frequency of dyspareunia (OR, 2.4), and pelvic floor pain (OR, 2.3) than those without defects.ConclusionsOur results suggest an association between postpartum sonographic anal sphincter defects, pelvic floor pain, and dyspareunia. A perineal height <2 cm, measured by bidigital palpation immediately postdelivery, was a risk factor for sonographic anal sphincter defect. We suggest offering pelvic floor sonography around 3 months postpartum to high‐ risk women to optimize diagnosis and treatment of perineal tears and include perineum <2 cm prior to primary repair as a proposed indication for postpartum follow‐up sonography.

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“…10 Chronic pain in scars of moderate-to-severe intensity occurs in 19% of adult Europeans 9 ; scars also lead to a restricted range of motion resulting in the reduction of quality of social and work life. 1 The first aid in pain reduction is analgesia, which can be applied topically or administered systemically. Unfortunately, oftentimes analgesia is not completely effective and does not avoid strong psychological repercussions: Recent estimates suggest that more than 20% of European patients with chronic pain have been concomitantly diagnosed with depression.…”

Section: Introductionmentioning

confidence: 99%

“…9 Different treatment approaches such as electrotherapy, laser, ultrasound, acupuncture, and intense pulsed light are routinely used to try to relieve pain and improve wound healing. 1 Autologous fat grafting (AFG) has been increasingly used in treating scars because of its demonstrated beneficial effect. It is a simple, safe, and repeatable procedure that can be applied in the restoration of skin quality and wound healing.…”

Section: Introductionmentioning

confidence: 99%

CD304+ adipose tissue–derived mesenchymal stem cell abundance in autologous fat grafts highly correlates with improvement of localized pain syndromes

Rezzonico Jost,

Lozito,

Mangani

et al. 2023

Pain

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Surgery, burns or surgery-free accident are leading causes of scars with altered tissue consistency, a reduced degree of motion and pain. Autologous fat grafting can dramatically improve tissue consistency and elasticity but less frequently results in the reduction of pain. Therefore, we analyzed different cell populations present within the adipose tissue to be engrafted and correlated them with the reduction of pain after surgery. Here, we identify a population of CD3−CD4−CD304+ cells present in grafted adipose tissue, whose abundance highly correlates with pain improvement shortly after surgery (r 2 = 0.7243****) as well as persistently over time (3 months later: r 2 = 0.6277****, 1 year later: r 2 = 0.5346***, and 4 years later: r 2 = 0.5223***). These cells are characterized by the absence of the hematopoietic marker CD45, whereas they express CD90 and CD34, which characterize mesenchymal stem cells (MSCs); the concomitant presence of CD10 and CD73 in the plasma membrane supports a function of these cells in pain reduction. We deduce that the enrichment of this adipose tissue–derived MSC subset could enhance the therapeutic properties of adipose grafts and ameliorate localized pain syndromes.

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Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review

Cited by 16 publications

References 106 publications

Effect of general and surface anesthesia on micro-plasma radiofrequency of hypertrophic scar: A retrospective cohort study

Effect of general and surface anesthesia on micro-plasma radiofrequency of hypertrophic scar: A retrospective cohort study

Sonographic postpartum anal sphincter defects and the association with pelvic floor pain and dyspareunia

CD304+ adipose tissue–derived mesenchymal stem cell abundance in autologous fat grafts highly correlates with improvement of localized pain syndromes

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