Overview
Chronic post-surgical pain (CPSP) is pain that develops or persists beyond the normal healing period following a surgical procedure — typically defined as pain lasting more than three months post-operatively that was not present before surgery. It affects an estimated 10–50% of surgical patients and is one of the most common yet underrecognized causes of chronic pain. Common presentations include post-mastectomy pain syndrome, post-thoracotomy pain, post-hernia repair pain, post-laminectomy pain (failed back surgery syndrome), and chronic pain following joint replacement. Dr. Migdale has specific clinical and research experience in post-surgical neuropathic pain, including a 2025 ASRA abstract on intercostal peripheral nerve stimulation for post-mastectomy and post-thoracotomy neuralgia.
Why Does Pain Persist After Surgery?
Post-surgical pain typically results from nerve injury during the surgical procedure — even in carefully performed operations, nerves can be cut, stretched, compressed, or entrapped in scar tissue. This nerve injury can produce a chronic neuropathic pain syndrome that may be severe and debilitating. In some patients, the surgical procedure may also sensitize the central nervous system, leading to an amplified, persistent pain response even after the tissue has healed.
Failed Back Surgery Syndrome
Failed back surgery syndrome (FBSS) refers specifically to chronic back or leg pain that persists or recurs after lumbar spine surgery. It is one of the most common indications for spinal cord stimulation and is an area where interventional pain medicine can offer substantial benefit after surgical options have been exhausted. Dr. Migdale evaluates and treats FBSS with a multimodal approach including neuromodulation, targeted injections, and functional restoration.
Research Focus: Post-Mastectomy and Post-Thoracotomy Pain
Dr. Migdale has specific research and clinical interest in post-mastectomy pain syndrome and post-thoracotomy neuralgia — two of the most common and distressing forms of post-surgical neuropathic pain. Her 2025 ASRA abstract describes a challenging case successfully treated with intercostal peripheral nerve stimulation, highlighting the potential of neuromodulation for these difficult presentations.