I am writing in response to the case study ‘Chronic abdominal pain and medication misuse’ published in the June 2020 issue of InMotion.

This article focused on applying a biopsychosocial approach to a woman who had chronic abdominal pain related to caesarean scarring.

I wanted to draw attention to the benefits of specific scar massage techniques for decreasing pain within this population and, more broadly, for those experiencing chronic pain and discomfort around a scar site.

Scar tissue can be a source of pain through several mechanisms, such as altered neural functioning peripherally and centrally, as well as intrinsic mechanical pain through adhesions.

One factor behind intrinsic scar pain appears to be the proliferation of C-fibres during the healing process, which become a source of ongoing pain and inflammation (Bijlard et al 2017).

There has been case study research to support the use of myofascial techniques, and in my own experience I have found that C-section scars (and other scars around problem areas) respond very well to these techniques regardless of the age of the scars (Wasserman et al 2016).

This may be due to a few different processes (Bijlard et al 2017, Wasserman et al 2016, Kobesova et al 2007):

• altering cognitive perceptions of pain in the case of allodynia or persistent numbness through decreasing central sensitisation/ uncoupling traumatic memories with non-painful therapeutic inputs


• improving underlying muscle activation through providing more afferent information to the affected area of the homunculus


• improving the local mobility of the tissues (including neural and visceral tissues) to decrease referred pain syndromes.

Scar massage therapy in this population is simple and can create immediate and long-lasting pain relief. It is worth trialling as part of the whole treatment.

Sarah Lawrence, APAM, Western Australia

>> Email inmotion@australian.physio for references.

References

A systematic review on the prevalence, etiology, and pathophysiology of intrinsic pain in dermal scar tissue. Bijlard E, Uiterwaal L, Kouwenberg CA et al. Pain 2017.

Chronic caesarian section scar pain treated with fascial scar release techniques: a case series. Wasserman J.B., Steele-Thornborrow, J.L., Yuen J.S., Halkiotis M, Riggins, E.M. Journal of bodywork and movement therapies. Volume 20, Issue 4, October 2016. Pages 906-913

Twenty-year-old pathologenic "active" postsurgical scar: a case study of a patient with persistent right lower quadrant pain. Kobesova A., Morris, C.E., Leit, K., Safarova M. Journal of manipulative and physiological therapeutics. Volume 30, Issue 3, P 234-238 March 2007.