Burn scars can cause ongoing pain long after a burn injury heals. For many burn survivors, scar tissue continues to cause discomfort and sensitivity. The level of pain varies from person to person depending on factors like the severity of the initial burn, location on the body, and effectiveness of scar management treatments. While burn scars may never be completely pain-free, there are ways to reduce scar pain and sensitivity over time.
What causes pain in burn scars?
Burn scars can be painful for several reasons:
Nerve damage
Severe burns often damage nerves in the skin. Scar tissue that forms after a deep burn can entrap damaged nerve endings, resulting in neuropathic pain. This nerve pain feels like burning, tingling, pins and needles, electric shocks, or extreme sensitivity in the scarred area.
Tightness
Scar tissue lacks elasticity and does not stretch well. Tight, inflexible scarring may limit movement and pull on surrounding skin, causing pain and discomfort. Tightness is especially problematic for scars over joints like the neck, elbows, knees, and fingers.
Changes in blood flow
Burn injuries and scarring disrupt normal blood circulation in the skin. Poor blood flow in scar tissue can contribute to ongoing pain. Blood vessels may become constricted or blocked. Alternately, new blood vessels may grow abnormally and be prone to inflammation. Changes in vascular structure and blood supply can result in pain.
External pressure
External pressure or friction on a scar may provoke pain. For example, clothing rubbing against a scar or pressure from a prosthetic worn over a burn may cause discomfort. Activities like exercising or playing sports can also put pressure on scars and trigger pain.
What does scar pain feel like?
People describe burn scar pain in different ways. Here are some of the most common sensations:
Sensitivity
Touching or exposing the scar may cause sharp pain, tenderness, or exaggerated responses to hot/cold temperatures. Even gentle stimuli like clothing or water may provoke discomfort.
Prickling, stinging
Scar tissue may provoke prickling, tingling, pins and needles, stabbing, or stinging sensations. These reflect underlying nerve problems.
Itching
Scars often itch, especially in the first year of healing. Itching may indicate inflammation in the healing scar.
Tightness, pulling
As a scar matures and contracts, it may feel tight and stiff. Tight scar tissue can pull on surrounding skin when stretching or moving the area.
Aching, throbbing
Some people describe a persistent dull ache or throbbing pain in their scars. This may result from chronic inflammation or changes in blood flow.
Spasms
Scars crossing joints may cause sudden muscle spasms or shooting pains when the joint moves, due to the scar’s inflexibility.
When does scar pain occur?
Immediately after injury
Burns are extremely painful injuries. Severe pain accompanies the initial damage to skin layers, nerve endings, and blood vessels. Early scar tissue forming in the first days and weeks after a serious burn may also be quite painful.
During healing
As burns heal into scars over weeks and months, the new scar tissue often feels uncomfortable. Scars may be extra sensitive or itchy during the remodeling process. Pain at this stage is a normal part of healing.
Long after healing
For many people with significant scarring, chronic pain persists for years or even lifelong. While some improvement is expected over time, pain and sensitivity may continue long after the scar has fully matured.
With movement or pressure
Scars may provoke pain only with touch or movement. For example, a shoulder scar may feel fine at rest but cause sharp pains when lifting the arm overhead. Pressure from clothing or prosthetics can also trigger discomfort.
With environmental exposures
Temperature changes, humidity, and sun exposure can all affect scars. Some people note increased scar pain in heat, cold, or high UV conditions.
With emotional responses
Psychological and emotional factors influence scar pain. Stress, anxiety, depression, and self-consciousness about disfigurement can make scars feel more painful.
Factors affecting scar pain
Several factors influence the likelihood and severity of pain in burn scars:
Severity of initial burn
More serious burns result in thicker, deeper scars more likely to cause chronic pain due to extensive nerve and tissue damage. Full thickness burns lead to the most painful scarring.
Location on the body
Scars on the neck, hands, feet, and over joints impair movement and are prone to pain. Areas that tend to stretch with movement or bear weight are more likely to provoke discomfort.
Size of burned area
Larger burn injuries result in more widespread scarring, increasing the areas affected by scar pain. The greater the total burned surface area, the more potential sites for problematic scarring.
Thickness and texture
Thicker, rope-like hypertrophic or keloid scars are more likely to be painful than flat, pliable scars. Rigid, inflexible texture causes scar tightness.
Skin pigmentation
Hypopigmented scars lacking normal skin coloration may be more sensitive to sun exposure, provoking pain.
Individual healing
The unique biology and genetics of skin healing means scar pain differs from person to person, even with similar burn injuries. Some people simply scar more extensively.
Ongoing conditions
Chronic inflammation, nerve compression, poor circulation, and other issues in scar tissue may cause persistent pain. Contractures, pruritis, blistering, and breakdown can also provoke discomfort.
Scar pain management approaches
While scar pain may never resolve completely, various treatments can provide relief and improve quality of life:
Medications
Oral or topical medications that may help reduce burn scar pain:
Corticosteroids
– Reduce inflammation
Non-steroidal anti-inflammatory drugs
– Alleviate pain and swelling
Nerve pain medications
– Neurontin, Lyrica, Cymbalta, lidocaine patches
Antidepressants
– Help chronic neuropathic pain
Over-the-counter analgesics
– Temporary pain relief
Compression
Pressure garments, custom braces, splints, or taping can help relieve pain from skin tightness and nerve compression.
Massage
Gentle massage techniques may help soften and loosen scar tissue, increase circulation, and reduce pain.
Ultrasound
Ultrasound therapy uses sound waves to improve scar pliability and potentially reduce discomfort.
Laser treatment
Lasers resurfacing scars can smooth texture, reduce inflammation and nerve sensitivity.
Steroid injections
Direct steroid injections into scars can locally reduce inflammation and pain.
Surgery
Operative procedures like scar release, skin grafting, and nerve decompression can relieve certain types of scar pain.
Physical therapy
Stretching exercises, massage, and modalities like heat/cold therapies can rehabilitate scars and painful areas.
Psychological treatment
Counseling, support groups, mindfulness, and coping techniques help patients handle chronic scar pain.
Tips for managing pain and sensitivity
Patients can take several steps at home to help minimize and cope with scar discomfort:
Protect scars
Padding scars, avoiding restrictive clothing, and protecting scarred skin from excess sun exposure can reduce pain triggers.
Moisturize regularly
Keep scars hydrated with moisturizer to improve pliability. Silicone sheets or gel are ideal.
Massage gently
Use light circular motions to massage scars a few times per day, which can help prevent adhesions.
Stretch carefully
Gently stretch and exercise scarred areas to maintain mobility, without overdoing it. Move joints through the full pain-free range of motion.
Wear compression
Ask your doctor about compression sleeves, stockings or wraps to reduce swelling and discomfort.
Try desensitization
Gradually expose scars to different textures and temperatures to desensitize over-reactive nerves.
Consider pain management tools
Explore medications, physical therapy, counseling, and complementary pain relief techniques.
Communicate with your care team
Discuss pain management options with your doctor and voice any concerns about scar healing.
When to see a doctor
Contact your healthcare provider if you experience:
– Sudden increase in scar pain
– Significant limitation of movement from scar tightness
– Areas of breakdown or wound separation
– Excessive redness, swelling or warmth
– Reopened wounds or fluid leaking from scars
– Pain not responsive to over-the-counter remedies
– Scar pain impacting sleep, relationships, work or quality of life
Seek prompt medical care for any concerning symptoms related to burn scars. Ongoing pain or physical limitations may require additional treatments or corrective surgery.
Conclusion
For many burn survivors, scars continue generating discomfort long after injuries heal. The extent of scar pain varies greatly but can significantly impact health and well-being. While scars may never be completely pain-free, today’s treatments can improve scar pliability and appearance while also reducing sensitivity. Managing burn scar pain requires patience and perseverance, but there are more options than ever to restore comfort, mobility and an enhanced quality of life.