Subcutaneous trigger point causing radiating postsurgical pain

The immediate onset of severe postoperative pain, especially pain radiating distant from the incision site, is uncommon after dermatologic surgery.

A 37-year-old woman undergoing excision of a nevus from the left side of her midback had an exquisitely tender spot along the incision lines. This tender spot was hard to anesthetize and was clinically visible, after excision of the nevus, as a fibrous bundle in the subcutaneous plane. She presented in the immediate postoperative period with referred (distant) pain extending down the ipsilateral arm that was caused by a thoracic subcutaneous trigger point.

Surgeons and pain management specialists should be aware of this potential cause of immediate postoperative pain to prevent unnecessary medical or surgical interventions in the postoperative period.