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Scar Tissue Removal

bjfergebbjferge Posts: 123
edited 06/11/2012 - 7:42 AM in Chronic Pain
Hi All,

I was reading a post on here started by Meydey about scar tissue, and possible treatments to remove it. They discussed laser, and convential surgery to remove it. They talked about an Fibrinolytic Enzyme Scar Tissue Removal, where they use an enzyme like Neprinol or Trevinol to break up the scar tissue. They also talked about study in the British Journal of Radiology, where they combined pentoxifylline (PTX)–tocopherol (Vit.E)to shrink the scar tissue over time.

I was wondering if anyone has tried any of these treatments? And how you did on them? What your dr had to say about any of these procedures? Are there any other procedure for scar tissue removal?

Thanks for your your help.
Bobbi Jo
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13

Comments

  • I don't know much about scar tissue removal, but in looking at different lumbar pain management options my doctor directed me to a pretty neat procedure they are doing to remove scar tissue from the lumbar spine. It's also used to treat disc issues, so if you look into it you'll find a lot about that. Basically, they thread an endoscope up through the epidural space in the lumbar spine and use a laser to remove scar tissue. I'm not sure where your scar tissue is, but if it's in the lumbar spine you may add that to your list of things to look into. This may have been mentioned in the other post as well? It's called the accurascope and it's done in Dallas. If you google accurascope you should come up with a link to some better info.
  • I have scar tissue in my neck from spinal surgery. The scar tissue is impinging on the nerve root exiting the spine and is causing tingling and muscle atrophy in my shoulder blade and shoulder. What can I do for this? Please advise
    Currently getting medical myofacial release trmnts & taking NSAI. It is very painful!
    Julie
    from what I have read, sounds like frozen shoulder syndrone
    04/09 Cervical Foraminotomy C5-6,C6-7
  • My pressure point guy said only to get laser trmnt (if all else fails, e.g. time & massages) for scar tissue breakup, because all other procedures have a huge risk of more scar tissue forming. This guy worked as an MD in viet nam, and has offered so much info & he gets so frustrated to see people in pain with no one out there to give them any direction.... like him ALOT
  • I'm trying this stuff to see if it helps. It is expensive so unless I see real results it will be the first and last purchase.

    My PT is working on my scar tissue. One side is smoothing out nicely. The other side is hard to break up. She has used a wooden dowel and literally dug it into my back. I can assure you it hurts. I have my wife working on it a bit every other day. It does help.

    Now that idea that it comes back. I don't get it. I thought it was like a scab. It goes away. I have to read up on this some more.

    Graham
  • I thought of someone on the board who could offer you some information. I just sent him a PM with a link to this thread, so I hope he'll see it. He's not on the board on a regular basis.
  • The deal with scar tissue reforming is when it is physically removed...like with the lysis of fibrosis procedure, or when a surgeon goes in and strips it out while performing additional surgery.

    When scar tissue is manipulated manually, the tissue is still present. It is just rearranged. The idea is that it is loosened up so it is not restricting other tissue. The collagen fibers are "organized" so they run in the same direction as muscle fiber, for example, rather than being all snarled up like a little kid's hair.

    I have no idea what happens if the tissue is chemically dissolved somehow....but it sounds scary.
  • Your PCP sounds great. Anyway I hope your appt with the psyiatrist goes your way. I know it will because you are so well informed and ready to take care of business. My NS decided against surgery to remove my scar tissue because of the risk of it growing back worse. I also have a tendency to form a lot of scar tissue so it's best to leave things as is. I did try having an ESI but it only aggravated my nerve pain. My doctor and I already were planning to go ahead with surgery to implant a pain pump anyway. Well, I wish you the very best and also success with this endeavor. Take care :H
  • Yes, a traditional surgery to remove scar tissue in the epidural space (epidural fibrosis as it is called on MRI) is very tricky because it is the bodies nature to rebuild the scar tissue in that area. I actually had the "Accurascope" procedure specifically to address my left side L4/5 nerve root scar tissue that had encased the nerve. They were able to release it with the laser and the latest MRI did not report any scar tissue issues. Unfortunately, I came out of surgery with some right leg issues that I didn't have beforehand (shin muscle didn't work), but it is slowly resolving. My current issues stem from the L4/5 disc itself.

    As for the PTX/Vitamin E study: I brought that study to the attention of my surgeon AFTER the first surgery (micro-d) when the MRI revealed the scar tissue problem and he was very encouraged and interested in it. We didn't go into any further exploration of its use as a viable option to minimize scar tissue internally, since I found a more immediate solution. I think the study is very worthy of being a possible treatment. Not sure how safe the PTX is over time though. The vitamin E component is what does the actual collagen breakdown because it is a free radical scavenger and the PTX is a peripherial artery drug (I believe), so it aids the vitamin E to get further into our bodies. That's how I understand it. If I had no other option, I would talk to my doctor again (bringing the study) and see what he/she thinks.

    http://bjr.birjournals.org/cgi/content/full/77/922/885#F1

    GL all. Scar tissue is a pain, that is for sure.

    ~BB

  • Good Luck Bobbi Jo! I hope the PTX/VIT E has the same effect on you. Please make sure it is safe for you to take. I think the quality of Vitamin E is VERY important. Your doc should know what to go with. :)

    Please keep us posted!

    ~BB
  • bj,
    please let us know what you decide to do. My PT said the only way to remove scar tissue without messing up something else, is to have it done with a "laser" - this guy works on doctors, nurses, & professional athletes. Have you exercised that option?
    julie
  • Ok so thanks for the brief explanation on the differences Gwennie. Honestly I never read up on this or gave it much thought. I figure with a MIS fusion with only small cuts affecting the small muscle tissue (myofacial) it wouldn't be a big deal. Silly me...

    My PT says it is indeed up on the surface and easy to feel. I most certainly feel it when she digs that stick in my back. I've found there are now 2 things that can make me cry. Rap music and that tool... LOL

    Now they also electrical stimulation. I assume it is a TENS unit. It has 4 pads they stick on me and then turn up the voltage until i feel the tingle and zapping. Then she sets some cyclic program. Honestly I think the the thing is useless. They tried it on me before surgery and I thought it was useless then. This is of course for me, I hear many who get relief. I don't think it is strong enough to break up scar tissue, but I could be wrong.

    How about ultrasound? That tends to get deeper without going to the extent of laser? I'm getting the point that you want to disrupt that hard chunk and get it to stay in line with the muscle. So why is this method not used?

    The laser idea seems to be becoming a catch all medical device for cutting things out. Supposedly less invasive than using a scalpel or drill. It's still burning tissue out of your body. I can't imagine that has no side affect?

    The chemically dissolving seems reasonable if the chemical can be that directed. I don't see too many drugs on the market that have no side affects. So we are all dealing with that with meds. Just a thought.

    I'll be very curious how you proceed with this Bobbie Jo and how it works out. Definitely keep everyone up to date as this seems to be an all too common issue post op.

    Graham
  • BJ-I have been told by many in different group practices in different states that scar tissue WILL come back. However, like you, always looking for new advances. Buckeye, I am definitely interested in looking up the info you provided.

    Graham-I swear by therapeutic scar tissue massage. It cannot get to the deep scar tissue around our nerve roots, but it certainly does free up the upper layers of muscle fascia and skin. I went to a PT place that uses a manual technique, no tools. Yeah, it felt like my skin was tearing, but I knew when the superficial scar tissue had been broken up because it would not hurt anymore in that spot where he was working. I invited my work comp nurse case manager into one treatment, and after being shown the difference from a treated area to a non-treated area, she was sold on the deal. Just mentioning that cuz it's pretty hard to sell anything to work comp.

    I understand that most of the medical community does not believe that ultrasound can break up scar tissue and is a waste of money(just what I've been told.) However, my PT mentioned to me that his facility was doing a study to use ultrasound before manual therapeutic scar tissue massage to document scar tissue before and after a series of treatments.

    What I've been told by my best injection guy is that he considers caudal epidurals to just be a $10,000 epidural and not worth the extra pain and money. Just what he said, never had one myself.

    BJ-please keep posting about this. There are so many of us out there with scar tissue issues or adhesive arachnoiditis. Good luck sweetie!!!!

    Angie
  • Like Graham, I've never even thought about scar tissue until recently, after I saw my PT this past week. I'd forgotten what he said to me and still don't remember the whole thing, but this thread reminded me.

    I still have some pretty strong pain in my back, especially on the left side, but I'm thinking it's pain from surgery recovery and the PT exercises. I'm just under three months post-op.

    My PT was looking at my scar and said something about it, I just can't remember what, but said I might want to start putting some Vitamin E on it. Is that what we're talking about here?

    My incision is 7" long, which I've been told is pretty long for a 1-lvl lumbar fusion, but I was also told that the problems were more extensive than they thought once they got in there.

    Anyway, like I asked above, is what we're talking about here why the PT told me to start putting Vitamin E on my scar?

    Cath
  • No, we are talking about epidural fibrosis...the collagen tissue that fills in whenever something is surgically removed from the body. It forms inside, adjacent to where something was altered. It is nature's way of filling a void. It is the same as a scar on the skin when you cut yourself, but the kind that is problematic is the deep scar tissue.

    It is a sticky substance. My surgeon said you can just peel it out -- they really do not cut it out, like you'd pare out a bad spot on an apple...it can be pulled out. The problem is that it just grows back. When it grows in up close to a nerve root, it causes the same symptoms as a bulging disc pressing on a nerve, for example.

    The fact that it just grows back is what makes removal so difficult. Rather than trying to remove it, it is more effective to attempt to "organize" the tissue at the time it is growing in. When the tissue grows in randomly, it can grow around a spinal nerve, entangling it...just like an out of control vine growing on a tree that eventually wraps itself tightly around the tree trunk. It is visible on MRI.

    Your PT is talking about effecting the cosmetic appearance of your scar that is on the surface of the skin -- it was formed by the same process, but it doesn't have the potential to cause damage like the "interior" scar tissue.

    Hope this helps...Oh, incidentally, there are some topical products for scar tissue that you can get at one of the big chain drugstores that are inexpensive and not as messy to use as vitamin E.

    Gwennie
  • I was looking for something else, and the first thing that popped up was the study that Graham referred to. If interested, here's the link:

    http://bjr.birjournals.org/cgi/content/full/77/922/885
  • I understand about the interior scar tissue and know how problematic it can be. It sounds like a catch 22 - you make a cut to take out scar tissue, then that cut creates more scar tissue. The laser thing sounds like a great improvement on that process.

    My PT just seemed concerned for some reason about my scar and I simply don't care how it looks. Nobody but my husband, my doctors and I will every see it - I'm WAAAAY past my bikini days. LOL I'll ask him about it tomorrow.

    Interestingly and off-topic, my PT put some of that black tape on my back on either side of my scar to help my muscles. I assume it's the same stuff that you see athletes have on them when you watch a sporting event. Apparently, it's supposed to be like little massage units that massage the muscles under it as you move to keep muscle spasming to a minimum. It stays on through showering and he told me Wednesday not to remove it until today. Interesting.

    Anyway, thanks Gwennie.
  • I know Graham reads medical studies. This one has some interesting photographs:

    http://www.nature.com/sc/journal/v41/n8/pdf/3101466a.pdf
  • Gwennie,

    The 1st article you showed was listed by buckeyeback earlier. That is from 2004. Seems like it covers 1 patient.

    The 2nd one you have is a case study. Interesting photographs for sure. Based on their study there is quite a difference between the subjects. Only problem with these cases is they are old and dated. That study was on 24 lab rats. 12 were the control group. Most of their references date back into the 90s and some the 80s. Hopefully there is more recent data out there.

    I can say for sure that at 6 months post op. If I am still having this kind of tightness and pain caused by this. I'm not letting my surgeon fluff it off. Since this is fairly time sensitive to decide that there is or is not scar tissue causing problems.

    What is sad when reading one of the references. It was documented in 1996 that a large contributor to FBSS was scar tissue. That's almost 15 years ago. Obviously it is naive of me, but I should think there would be some realistic solutions to this. Especially in the immediate post-op time frame, to help stave this off.

    Graham
  • Could scar tissue be the culprit behind my current pain? This particular pain did not start until approx 15 weeks post op. I know scar tissue takes time to develop. My surgeon is totally blowing me off about this pain. He has done his part apparently.

    Traci
  • Hey everyone,

    Today I went to my normal PT appt. And my therapist (Tracy, too!) and I were discussing scar tissue. She is also amazed with the number of lumbar, cervical, thoracic surgeries performed here in the states, there are no current studies on scar tissue and the effects on nerves, etc.

    She very specifically started looking at my scar and touching and pressing it, she says she can feel the scar tissue directly under my incision. She said if I can feel it can you imagine what kind of scarring is deeper? She started a massage and then used a knobby stick thing to prod at my back, made me cry. Then she used ultrasound to massage and says it goes deeper. I go to PT again Thursday. We will see. She is also emailing my Surgeon for a script for aquatics therapy, she thinks that will be most beneficial. I think I trust her more than my physician at this point. So, I am in pretty dreadful pain this evening. Hopefully I make it until Thursday.

    Best Wishes,
    Traci
  • Hi everyone,

    I am learning more about my situation from this forum than anywhere else. My doctor keeps telling to be patient, but he first told me that there was a 80-90% chance that 6-8 weeks after a L5-S1 fusion that I would be back to work fulltime, off of all meds, and should be pain free. Well, here I am at 11 weeks post-op and the pain in my back and my rear is worse than before surgery. Now he is saying it could take up to 6 months. What's up with that?

    I just received my MRI results after waiting by the phone for almost a week. I definitely have scar tissue formed around the nerve root at L5-S1. In a previous discectomy, the NS had to cut away a lot of scar tissue from the nerve root, and oops, he cut the dura by accident. Apparently, the scar tissue grew back again with a vengence and it is causing my current pain.

    Starting next week, my disability benefits expire and I will be taking a 40% cut in pay because I can't put in a full day (presently working 5-6 hours per day from home) and still taking a fair amount of Norco (hydrocodone) to "manage" the pain, which can be so aggravating that I can't even think.

    So... I'm convinced that time is not the answer and I'm intrigued by the laser option. Not sure about PTX and it's ability to dissolve a significant mass of scar tissue that is adhering to the nerve root.

    I am doing a very rigorous PT regimen twice a day plus aquatic therapy nearly every day. Is this really the answer?

    I know that I need to talk to my doctor, but if all he is able to say is "be patient", I'm thinking that I need to find a doctor who is as concerned as I am about this scar tissue problem and the fact that it is aggravating the nerve and constraining my life. I'm afraid that if I wait too long, it will become more difficult to somehow correct this "tissue issue".

    Thanks again, everyone!

  • Breitsd,

    It sounds like you and I are in identical boats. My surgeon says the same, but he will not order an MRI to see what my problem is. Hence me trusting my physical therapist more than him right now. Hopefully new PM Dr will do more tests to discover if scar tissue is my issue. Hey, that rhymed!!

    Best wishes,
    Traci

    P.S. My pain is approximately an 8-9 today, I can barely move. No more massage please and that knobby stick can go...
  • I talked to my physical therapist today and she has her doctorate in PT (I don't know what the actual degree is). She said that most of her graduate research was in the area of treating scar tissue that forms adjacent to, or adheres to, the nerve roots near the spine. I think she is very honest and isn't just trying to give me false hope. She says that it can take weeks or even months to break the nerve root free from scar tissue that has formed around it in the foramina area (I think that's what it's called -- the opening in the side of the vertebrae where the nerve root comes out). In my case, it's the S1 nerve root. So, I will remain diligent with my PT exercises, and do my best to be patient, but I feel like time is working against me. I don't know how long I can keep my job working part-time from home. However, what choice do I have? She strongly urged me not to try anything drastic like laser surgery, endoscopic tissue removal, PTX, etc. I take it that she truly believes that this will eventually resolve.
  • I hope she is right. I am also staying on top of stretches,even though they hurt like hell right now. And I will keep seeing my PT, she has doctorate in pt and something else, memory fails me at this hour.

    Good Luck,
    Traci
  • Trasee said:

    She started a massage and then used a knobby stick thing to prod at my back, made me cry. Then she used ultrasound to massage and says it goes deeper.
    Yeah Traci. That is exactly what I was talking about in my post above. Until you have felt someone dig that into your muscles you just can't appreciate how painful it is. Even better, mine pushes hard under my shoulder blade to tighten the muscles and pull up. She has me kneeling leaned forward in what looks like a mid-eastern prayer stance. Your muscles are super tight at that point. Then she dug away at it for a few minutes. She has 2 of them and uses 1 behind the other.

    Like I said, only that and rap music brings tears to me eyes... LOL You would think we were into S&M or something letting people do that to us!!! Wink

    Now that said. It does work! It's just very crude.

    I'm really curious on the ultrasound. Mine did not use that after. I'm going to ask her why not. When I used to see a Chiro he used ultrasound and swore by it.

    Graham
  • Hi Graham,

    I totally understand why you cry from both LOL. When I did PT today, my therapist strictly did deep massage manually and untrasound. I was just too sore from Tuesday. No sharp stick in the back. My right side is so guarded at this point, she even made my skin ache. Here's hoping somethung works. I am starting aquatic therapy Monday.

    Best,
    Traci
  • Thank you so much for posting this. I hadn't seen this study before but have read quite a few Articles written by Doc Sarah. From what I can gather, there might be a small glimmer of hope for those that suffer from Epidural Fibrosis but those of us who suffer with AA (myself included) still have a long wait ahead of us.

    Currently, my AA is still progressing, albeit at a very slow pace. I'm hoping that I plateau soon and wish the same for anyone suffering from this condition.

    Dave
  • One suggestion for anyone getting therapeutic scar tissue massage: Always use a moisturizing lotion after treatments. This allows your skin to stretch more and not leave that red mark you sometimes get. Don't oil up right before session as they'll just have to use alcohol to wipe it off.

  • My NS is concerned with my amount of scar tissue from the last 2 cervical surgeries. He hasn't gotten too fussy about it yet, but where I am possibly facing him going back in to remove hardware (to give me my vocal cords back!!), it adds to it. So far, I am okay, but threads such as you started Bobbie Jo, gives me KNOWLEDGE should removal become an issue. Thanks for putting all of this out. *HUG*

    Brenda
    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Bobbi Jo,

    Thanks for your posts. I hope this thread can help many people make more informed decisions. Myself included. The more we know and the more research that is done can only help.

    All of my symptoms point to scar tissue causing the pain. After so many procedures, I am not surprised. My surgeon is fellowship trained spinal reconstructionist. I am really surprised he is not more aware of this being an issue following surgeries. If he is, he certainly isn't admitting it to me.

    I wish everyone the best in finding a treatment that will work.

    Again BJ thanks. I also send you big hugs. We all need some semblence of a normal life. Or at least some relief.

    Best Wishes,
    Traci
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