Post-Surgical Nerve Pain Self-Assessment
A quick safety check, then ten questions about your surgery and your pain. About four to six minutes. Built around the clinical patterns Dr. Alex Movshis uses in office to identify which peripheral nerve is the most likely source of chronic pain after hernia repair, C-section, hysterectomy, mastectomy, and laparoscopic abdominal surgery.
Loading the assessment…
What the assessment covers
The Modal Pain self-assessment is a pattern-recognition tool that maps the symptoms of post-surgical chronic pain to the peripheral nerve most likely to be the source. It is built around the clinical patterns Dr. Alex Movshis, MD — a dual-board-certified anesthesiologist and pain medicine physician in Midtown Manhattan — uses to triage new-patient consults. The assessment is educational; it is not a diagnosis.
Questions the assessment asks
- Safety check (14 yes/no items). Screens for post-surgical emergencies — pulmonary embolism, deep vein thrombosis, cauda equina, surgical- site infection, ischemic orchitis after groin repair, ureteral injury after pelvic surgery. Any positive answer stops the assessment and routes the patient to the emergency department.
- Which surgery preceded the pain. Hernia repair (open or laparoscopic), C-section, hysterectomy or pelvic surgery, mastectomy or axillary surgery, laparoscopic abdominal surgery, or other.
- How long ago the surgery was. From less than three months to more than ten years.
- When the pain first started. During surgery, within two weeks, weeks to months later, after healing, or comes and goes.
- Where the pain is located. Twenty named body regions — groin, lower abdomen, suprapubic, lateral abdomen (trocar sites), pelvic floor and vulva, medial and inner thigh, axilla, medial upper arm, chest wall — plus a free-text description.
- What the pain feels like. Burning, sharp, electric, aching, numbness, tingling, hypersensitive to light touch, or deep pressure.
- DN4 self-screen (7 items). The validated Bouhassira DN4 neuropathic-pain questionnaire, self-report subset — burning, painful cold, electric shocks, tingling, pins and needles, numbness, itching.
- What makes the pain worse. Light touch or clothing pressure, specific movements, sitting still, lying on one side, coughing or straining, temperature changes, stress, or sexual activity (for pelvic regions).
- Treatments tried so far. OTC and prescription painkillers, nerve medications (gabapentin, Lyrica, duloxetine), physical therapy, injections, alternative therapies.
- Treatment response. Nothing helped, some things gave temporary relief, haven't tried enough, or some things gave lasting relief.
- Prior tests. Imaging (MRI, CT, ultrasound), nerve conduction study or EMG, diagnostic injection, gynecologic exam, surgical re-evaluation, or none.
- Your main question. Is this a nerve problem? Do I need another surgery? What treatments might help? Why hasn't anyone figured this out? Is this permanent?
Conditions the assessment can identify
Based on the answer pattern, the assessment routes to one of eleven educational outputs. Each output names the peripheral nerve most likely involved, explains why the pattern is commonly missed, describes what an in-office evaluation involves, and links to the relevant Modal Pain service page and the underlying peer-reviewed literature.
- Ilioinguinal, iliohypogastric, or genitofemoral neuralgia after hernia repair. About 10 to 15 percent of patients who have a major hernia repair develop chronic nerve pain in one of these three territories (Aasvang & Kehlet, Br J Anaesth 2005). The diagnostic move is an ultrasound-guided nerve block, nerve by nerve.
- Ilioinguinal or iliohypogastric nerve entrapment after a low horizontal (Pfannenstiel-type) C-section incision. Roughly one third of patients have chronic pain at the Pfannenstiel scar at two years, often misdiagnosed as endometriosis or pelvic-floor dysfunction (Loos et al., Obstet Gynecol 2008).
- Post-hysterectomy peripheral nerve injury. The exact nerve depends on the surgical approach — ilioinguinal and iliohypogastric for open or Pfannenstiel-approach hysterectomy, genitofemoral for laparoscopic or robotic, obturator for radical hysterectomy with lymphadenectomy.
- Pudendal neuralgia after a vaginal or vaginal-cuff procedure. Diagnosed by the Nantes criteria — pain in the pudendal nerve territory, worsened by sitting, no nocturnal awakening, no objective sensory loss, and a positive anesthetic block (Labat et al., Neurourol Urodyn 2008).
- Intercostobrachial neuralgia after mastectomy or axillary surgery. The most consistent post-mastectomy / axillary-dissection pattern. About a quarter to two thirds of post-mastectomy patients develop chronic pain in this territory depending on the extent of axillary surgery (Andersen & Kehlet, J Pain 2011).
- Mastectomy with numbness only in the intercostobrachial territory. A known and expected consequence of axillary lymph node dissection that does not need a block — but does deserve an explanation.
- Trocar-site cutaneous nerve injury after laparoscopic abdominal surgery. Mechanism-equivalent to anterior cutaneous nerve entrapment syndrome (ACNES); diagnosed and treated with an ultrasound-guided block at the rectus sheath, with anterior neurectomy as the surgical option for refractory cases (Boelens et al., Ann Surg 2013).
- General post-surgical peripheral nerve injury for atypical or mixed distributions that an in-office cutaneous exam can localize.
- Lasting-relief consolidation consult for patients who are responding well to current treatment and want to plan for durability.
- See-surgeon-first guidance for patients still in the acute post-operative window or whose pain quality does not yet suggest a peripheral-nerve generator.
- Emergency department routing for any positive item on the safety check.
What evaluation involves at Modal Pain
The first visit pairs a focused in-office cutaneous exam with a same-day ultrasound-guided diagnostic nerve block when the exam supports one. The block is the test that resolves the diagnosis — if the numbing medicine cuts the pain by half or more during the 30 to 90 minutes it is active, that nerve is confirmed as the source. With an anti-inflammatory medication added to the injection, the same procedure typically gives 4 to 12 weeks of relief. Patients who respond well but briefly are candidates for a longer-acting procedure called pulsed radiofrequency ablation, which usually delivers 6 to 12 months of relief. Modal Pain Management is located at 369 Lexington Avenue Floor 25 in Midtown Manhattan. Same-week new-patient consults are routinely available. The practice does not accept Medicare; it works with most commercial PPO insurance plans, and the office team verifies coverage before scheduling.
Frequently asked questions about post-surgical nerve pain
Usually no. MRI and CT are good at finding mesh problems, hernia recurrence, abscesses, or hardware issues — they are poor at finding peripheral nerve injury. A normal scan after surgery does not rule out the nerve being the source of the pain. The test that actually finds the nerve is an ultrasound-guided diagnostic block.
Pain that persists past three months after surgery meets the international definition of chronic post-surgical pain. For peripheral-nerve-injury patterns (ilioinguinal, intercostobrachial, anterior cutaneous, pudendal, genitofemoral), the natural history without targeted treatment is that the pain persists indefinitely. With a targeted block plus an anti-inflammatory medication, the relief window is usually 4 to 12 weeks; pulsed radiofrequency ablation extends this to 6 to 12 months.
Sometimes. Nerve medications (gabapentin, pregabalin, duloxetine) work by quieting overactive nerves and can be a complete answer for some patients. But they do not address the mechanical generator — the suture, the mesh contact, the scar tethering — and side effects (sedation, weight gain, brain fog) push many patients off them. A diagnostic nerve block answers the question of which nerve is the source so that the next-step decision can be informed rather than empiric.
An ultrasound-guided injection of numbing medicine right next to the suspected nerve. The procedure takes 10 to 15 minutes in the office. If the numbing medicine cuts your pain by half or more during the 30 to 90 minutes it is active, that nerve is confirmed as the source. With an anti-inflammatory medication added to the same injection, the procedure typically becomes therapeutic for 4 to 12 weeks.
Surgeons rarely follow patients into chronic post-surgical pain because their training focus is the operation itself. The workup they run — recurrence imaging, hernia ultrasound, mesh review — is good at finding what their operation can produce, but a peripheral nerve injury rarely shows on those tests. A normal workup does not rule out a nerve generator; it means the next step is a peripheral-nerve evaluation, not a second operation in the same field.
The DN4 (Douleur Neuropathique 4) is a validated 10-item questionnaire developed by Bouhassira and colleagues in 2005 to screen for neuropathic pain. Seven of the ten items are patient-reportable without an exam; the remaining three require bedside touch and pinprick testing. This assessment uses the seven self-report items as an independent second read alongside the pattern-recognition output. The validated cutoff for the full 10-item DN4 is four or more out of ten; the seven-item self-report subset uses three or more out of seven as the screening threshold.
Most commercial PPO insurance plans cover ultrasound-guided diagnostic nerve blocks when documented as part of a chronic post-surgical pain workup. Modal Pain Management does not accept Medicare; the office team verifies your specific coverage before scheduling. If your insurance is Medicare-primary, the assessment is still useful information for sharing with your existing care team.
Related but not identical. "Scar tissue pain" is a colloquial term that covers two distinct mechanisms: a tangled nerve ending caught in a healing scar (a scar neuroma, which produces a focal painful spot reproducible by pressing), and a nerve tethered by scar a few centimeters away from the visible scar line (entrapment, which produces a band of pain along the nerve's skin distribution). Both are diagnosed and treated with an ultrasound-guided block. Modal Pain treats both under the post-surgical and iatrogenic nerve pain service line.
Yes. The peripheral nerves that get injured during surgery do not heal themselves spontaneously over a decade. Patients who have been bouncing between specialists for ten or more years are the population the long-time-course rules in this tool are built for — that history with a negative workup is itself part of the pattern.
Yes. Answer based on what the patient describes. The assessment does not collect identifying information and your answers stay on your device unless you choose to submit the contact form at the end. Bring the result (or share the URL) at the consult — the office team uses the result to plan the visit.
What happens after the assessment
If the tool lands on a high- or moderate-confidence post-surgical nerve hypothesis, the recommended next step is a consult with Dr. Movshis at Modal Pain Management, 369 Lexington Avenue Floor 25, in Midtown Manhattan. Same-week new-patient consults are routinely available.
The first visit pairs a focused in-office cutaneous exam with a same-day ultrasound-guided diagnostic block when the exam supports one. The block is the test that resolves the diagnosis: a positive response (≥ 50% pain abolition in the working window) confirms which nerve is the generator and, with corticosteroid added, is therapeutic for 4 to 12 weeks.
Modal Pain Management does not accept Medicare. We work with most commercial PPO insurance plans, and the office team verifies your specific coverage before scheduling. If your insurance is Medicare-primary, the assessment is still useful information to share with your existing care team. Major NYC institutions that treat post-surgical peripheral nerve pain under Medicare include the Hospital for Special Surgery Spine & Pain Center, the NYU Langone Comprehensive Pain Care Service, the Weill Cornell Center for Comprehensive Spine Care, and the Mount Sinai Pain Management Service. We are happy to coordinate a referral; call (646) 290-6660.
Read about post-surgical nerve pain at Modal Pain or read about Dr. Movshis.