Affiliation:
1. 1 Department of Plastic and Reconstructive and Hand Surgery. Erasmus MC, Erasmus University Medical Centre Rotterdam, The Netherlands
Abstract
Background: Scars can cause pain, even without symptoms of underlying nerve damage. A lack
of knowledge on intrinsic scar pain hampers effective treatment of these complaints.
Objective: Aggregate current knowledge on the prevalence, etiology, and pathophysiology of
intrinsic pain in dermal scars.
Study Design: Systematic review.
Setting: University Medical Center.
Methods: We searched the Embase, Medline, Cochrane central, CINAHL, Web-of-Science, and
Pubmed databases with search terms: scar, skin, pain, and etiology/pathology, adding all synonyms
of these terms. Relevant papers were selected and analyzed by 3 reviewers.
Results: Intrinsic pain in scars has a low prevalence. However, pathologic scars and burns
regularly cause pain of high intensity. The etiology is multifactorial, the extent of trauma was
an important predicting factor. Nerve fiber density did not explain the intrinsic pain when panneuronal markers were used, while a correlation with an increased number of C-fiber subtypes
seems plausible. Nerve growth factor (that stimulate these C-fibers) plays an important role in
wound healing. Thereby, it also sensitizes neurons and promotes inflammation, releasing even
more neurotrophic factors. Central sensitization causes a long-lasting effect even after wounds are
healed. Furthermore, the opioid-system, that influences inflammation and healing and possible
systemic sensory alterations after injury, is discussed.
Limitations: Liberal selection criteria challenged the systematic selection of papers.
Conclusions: Burn and pathologic scars often lead to high intensity pain symptoms. This pain
has many characteristics of neuropathic pain that could be caused by an imbalance of C-fibers
subtypes. The scar tissue itself may alter the nerve fiber distribution; the imbalance results in
ongoing neuro-inflammation and pain symptoms.
Key words: Systematic review, scar, pain, epidermal innervation, prevalence, neuro inflammatory
response, peptidergic fibers
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
39 articles.
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