Neuropathic scar pain following Caesarian section
Presentation
A 39 year old was seen in the Pain Clinic. On examination, there was a small discrete area in the left iliac fossa approximately 1 x 2 cm superior to the lateral margin of the pfannenstiel incision. Palpation of the area reproduced the pain on very superficial palpation. There was also altered sensation with an increase in pin prick sensation and increase to sensation of light touch, corresponding to hyperalgesia and allodynia.
Diagnosis of neuropathic scar pain
A diagnosis of neuropathic pain was made, most likely secondary to a neuroma secondary to multiple surgeries including laparoscopies which she had undergone.
Treatment options in neuropathic scar pain
We discussed the various treatment options with this lady including Lidoderm patches, anti-neuropathic medication and local injections of local anaesthetic and steroid. It was the last treatment which she decided to go with. This was performed using aseptic technique with an injection of Bupivacaine and Depo-Medrone locally to the area under local anaesthetic.
Treatment follow-up and outcome
At 4 months the pain was significantly diminished and she was very happy with the results, although she was keen to improve upon this. She was therefore booked for a further injection. We also discussed the possibility of using pulse radiofrequency to the area to try and improve her symptoms.
