Active scars in clinical presentation of postoperative persistent syndrome (Failed back surgery syndrome)

Abstract

Objective. To assess the role of postoperative scar trigger zones in patients with postoperative persistent syndrome (POPS), effec-tiveness of lidocaine/prilocaine cream and manual treatment methods. Material and methods. Three groups of patients were examined and treated: 1) «early POPS» (e-POPS, n=23), pain after surgery decreased, but continued to significantly disturb the patient; 2) «middle POPS» (m-POPS, n=42), complete regression of pain af-ter surgery with subsequent recurrence within 6—12 months; 3) «late POPS» (l-POPS, n=31) — pain relapse occurred later than 12 months after surgery. Examination included manual diagnosis of skin and soft tissue thresholds within the scar area, tensoalgom-etry with a 1 mm2 nozzle. Treatment included 2 stages: 1) lidocaine/prilocaine cream application on postoperative scar for 2 hours daily for 5 days; 2) manual therapy with soft tissue stretching and pressure. Results. All patients showed a decrease in physiological barrier of skin and soft tissues around the scar by 5—10 mm. Tensoal-gometry revealed scar trigger zones (STZ) in all patients of the e-POPS group with reproduction (complete or partial) of typical pain pattern. The same STZs were found in all patients of other subgroups, but pain pattern reproduction was found in a smaller number of patients (m-POPS subgroup — 13 out of 42, l-POPS subgroup — 2 out of 31). Tensoalgometry data (kg/cm2): e-POPS before treatment — 21.2±12.5, after the first stage of treatment — 64.3±19.5 (p=0.00045), after the second stage of treatment — 87.6±13.5 (p=0.0054); m-POPS before treatment — 51.5±23.2, after the first stage of treatment — 71.5±31.7 (p=0.0054), after the second stage of treatment — 91.4±34.9 (p=0.0043); l-POPS before treatment — 61.3±33.6, after the first stage of treatment — 81.7±41.7 (p=0.035), after the second stage of treatment — 88.7±42.5 (p>0.05). Conclusion. Lidocaine/prilocaine cream showed a good analgesic effect for 4 hours in all patients. Manual therapy also significantly increased pain thresholds, except for the l-POPS group. These patients had a significant effect after lidocaine/prilocaine cream application. The authors recommend lidocaine/prilocaine cream in addition to conventional manual therapy for the treatment of active scars. This cream is characterized by high efficacy, safety and good tolerance.