Elastic Taping; A Non-Drug Therapy with Potential to Prevent Chronic Post-Op Neuropathic Pain.

Each year, more than 230 million surgical procedures are performed worldwide.

Although most surgical wounds will heal well, almost half will result in persistent post-surgical pain, with as many as 40% of post-op patients reporting symptoms consistent with neuropathic pain.

Usual post-surgical pain resolves naturally as tissue healing progresses and is physiologically different to neuropathic pain, which is a complex and often misunderstood condition that may persist long after wound healing has occurred, and can significantly reduce quality of life (1,2).

Caused by either direct nerve damage, or sensitisation due to excessive or prolonged nociceptor messaging, long term neuropathic pain can result in central nervous system lesions and remodelling.

Therefore early attention to post-operative pain management is essential to mitigate unnecessary progression due to nociceptor overload.

For surgical teams and allied health professionals working in post-operative rehabilitation, there is a growing need to adopt multimodal, non-pharmacological strategies for managing post-surgical pain, and to prevent long term post-operative neuropathy.

Elastic taping therapies have emerged over the last half century as a promising, low-risk intervention with the potential to reduce pain, facilitate recovery, and improve function in post-surgical neuropathy.

This post reviews the mechanisms of action in elastic taping with reference to wound healing and the pathogenesis of chronic post-surgical neuropathic pain.

How Normal Post-surgical Pain becomes Chronic Neuropathic Pain

Post-surgical pain can be broadly categorised into usual (nociceptive) pain and neuropathic pain.

Usual pain is a normal physiological response to tissue damage, typically described as dull, aching, or throbbing.

It is generally localised to the area surrounding the surgical site, and typically decreases as the tissue heals and inflammation subsides.

Since the origin of nociceptive pain is stimulus is by inflammatory mediators and chemicals from cellular damage present in the tissue spaces, post-surgical pain is usually managed with non-opioid and non-steroidal anti-inflammatory medications.

Neuropathic pain, on the other hand, is caused by damage or irritation to the nerve itself, leading to abnormal nerve signals which are not directly related to the extent of tissue damage.

This can be caused by nerve compression, surgical injury, traumatic injury such as sporting fractures, or phantom limb pain.

Characterised by sharp, shooting, burning, or tingling sensations, and sometimes described as like an electrical shock, stronger pain relief such as opioids, and anti-convulsive and anti-depressant medications are typically employed to manage post-surgical neuropathic pain.

Neuropathic pain can be localised to the surgical site or may radiate to other areas, even after the initial wound has healed. As nerve repair progresses more slowly than connective tissue repair, post-surgical neuropathic pain may persist long after tissue damage from the the surgery has healed.

Chronic Post-Surgical Neuropathic Pain

Nerve-related pain that continues for more than three months following a surgical procedure is considered chronic, and can be the result of direct nerve injury, prolonged inflammation, or sensitisation of the nociceptor pathway.

Symptoms may manifest as burning, tingling, shooting pain, or numbness. While some cases can be mild and temporary, others are long-lasting and severely debilitating (3).

Prevalence varies depending on the type of surgery, but it's notably common after breast and abdominal surgeries where 20 - 30% of patients report chronic post-surgical pain, and up to 2% of cases will suffer permanent nerve damage (4,5).

Risk factors include pre-existing pain, and long term issues are more prevalent among younger women and people who experience anxiety, while certain surgical techniques will carry a greater risk of causing nerve trauma than others.

Furthermore, neuropathic pain remains underdiagnosed and undertreated, in part because standard pain protocols don't always account for it (3).

Current Pain Management: Gaps and Opportunities

Systemic medications including opioids, NSAIDs, antidepressants, and anticonvulsants are the primary intervention for post-surgical pain.

Calamine or lidocaine patches can be used to provide localised pain relief, and neural blockers can be injected to interrupt nerve signals and reduce pain.

However, pharmaceutical therapies are often accompanied by unwanted side effects such as dizziness, fatigue, or risk of dependency, and interest is growing in multimodal pain management: combining pharmacological and non-pharmacological methods to optimise recovery and minimise reliance on any single modality.

Exercises and physical therapy techniques can help improve range of motion and reduce pain, and psychological support to develop coping strategies can help address the emotional impact of chronic pain.

Among other emerging scar and pain management modalities, elastic taping offers distinct advantages.

Elastic Taping Therapy: How It Works

Example of neuro-muscular taping method.

Elastic taping involves the application of flexible, adhesive tape over skin and muscles to improve lymphatic and blood flow, provide structural support, and alter sensory input to the nervous system (8).

When applied correctly, the tape gently lifts the skin, decompresses underlying tissues, and stimulates cutaneous mechanoreceptors (9).

This mechanical action may reduce inflammation, assist tissue perfusion and fluid drainage, improve joint proprioception, and crucially for preventing progression to neuropathic pain, modulate pain signals before they reach the central nervous system.

The Evidence Behind Elastic Taping

As an evolving therapy, the specific method of applying the tape can vary widely and this imposes a significant limitation on the ability to conduct systematic reviews or meta analyses on a specific methodologies.

Never-the-less, several studies support the efficacy of elastic taping in the reduction of post-surgical oedema, and management of chronic pain.

Elastic taping has been shown to improve scar elasticity and reduced discomfort in patients with hypertrophic scars, suggesting positive effects on both sensory and mechanical properties of healing tissue.

In patients with chronic venous insufficiency, taping led to reduced leg heaviness and pain, showing its effectiveness in improving local fluid dynamics, and the stimulation provided by the tape appears to interfere with the maladaptive neural firing patterns seen in central sensitisation, a key process in chronic pain development.

In a post-operative setting, this means taping may not only reduce immediate pain and swelling but may also play a role in preventing central nervous system changes that give rise to chronic pain syndromes.

Opportunities and advantages for Allied Health Practitioners

For physios, remedial therapists, and OTs, taping is:

• Non-invasive and cost-effective

• Easily combined with movement therapies

• Well-tolerated by patients

• Adaptable across surgical contexts

Additionally, taping empowers clinicians to extend care beyond passive recovery. It supports early mobilisation, an essential goal in modern rehabilitation, and may reduce reliance on opioids during vulnerable periods of healing.

Practical Considerations for Clinicians

Implementing taping protocols requires appropriate training to ensure correct application, especially in areas with sensitive surgical wounds or scars.

Allied health professionals should tailor taping techniques to the surgical site and stage of recovery, educating the client to monitor for signs of skin sensitivity or improper placement.

Taping can be easily combined with manual lymphatic drainage, or guided exercises as part of a comprehensive plan to produce synergistic effects.

Client feedback should untimely guide use. By tracking improvements in pain, swelling, range of motion, and overall function clinicians can optimise outcomes and justify ongoing treatment.

Conclusion: A Gentle Intervention With Powerful Potential

In a healthcare landscape striving to reduce opioid dependence and improve quality of life, evidence-backed, non-pharmacological therapies like elastic taping aren't just an option - they're a necessity.

With chronic postsurgical pain posing an increasing challenge, allied health professionals are uniquely positioned to shift the recovery narrative.

More trained Therapists are needed to raise awareness of this rapidly evolving therapy, and high quality research on the various elastic taping styles is needed to ascertain the optimum application in the management of post-operative pain.

Elastic taping offers a gentle, effective, and empowering tool to support healing, reduce pain, and potentially interrupt the progression toward chronic neuropathic syndromes.

References

1. Borsook, D., et al. (2013). "Surgically induced neuropathic pain: understanding the perioperative process." Ann Surg 257(3): 403-412.

   Nerve damage takes place during surgery. As a consequence, significant numbers (10%-40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in "peripheral and central sensitization," with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients, these initial events produce chemical, structural, and functional changes in the peripheral and central nervous systems (CNS). The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state-allodynia, sensory loss, shooting pains, etc, that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed "centralization of pain" and affect sensory, emotional, and other (eg, cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (eg, depression). Currently there are no objective measures of nociception and pain in the perioperative period. As such, intermittent or continuous pain may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition, appear to provide initial opportunities for decreasing the burden of SNPP, until treatments with high efficacy and low adverse effects that either prevent or treat pain are discovered.

2. Prudhomme, M., et al. (2020). "Management of neuropathic pain induced by surgery: Review of the literature by a group of experts specialized in pain management, anesthesia and surgery." Journal of Visceral Surgery 157(1): 43-52.

   Summary Chronic postsurgical neuropathic pain (CPSNP) is frequent. While prevalence varies considerably according to type of operation and means of evaluation, it can reach 37% following breast surgery. Identification of risk factors related to the procedure and to the patient and taking into account the development of new, minimally invasive surgical techniques is increasingly nerve-sparing and reduces the likelihood of injury. CPSNP diagnosis in daily practice is facilitated by simple and quickly usable tools such as the NP4 4-question test. Management is based on pharmacological (analgesics, antiepileptics, antidepressants, local anesthetics) and non-pharmacological (kinesitherapy, neurostimulation, psychotherapy) approaches. In light of the present review of the literature, the authors, who constitute an expert group specialized in pain management, anesthesia and surgery, express their support for topical treatments (lidocaine, capsaicin) in treatment of localized postsurgical neuropathic pain in adults.

3. Neuropathic Pain – A Stepwise Approach, 2013 https://bpac.org.nz/BPJ/2016/May/docs/BPJ75-pain.pdf

4. Chen, Q., et al. (2023). "Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries." Front Neurol 14: 1258759.

   Although non-invasive and minimally invasive aesthetic procedures increasingly dominate the cosmetic market, traditional plastic surgery remains the most effective improvement method. One of the most common complications in plastic surgery, peripheral nerve injuries, though has a low incidence but intrigued plastic surgeons globally. In this article, a narrative review was conducted using several databases (PubMed, EMBASE, Scopus, and Web of Science) to identify peripheral nerve injuries following cosmetic surgeries such as blepharoplasty, rhinoplasty, rhytidectomy, breast surgeries, and abdominoplasty. Surgery-related nerve injuries were discussed, respectively. Despite the low incidence, cosmetic plastic surgeries can cause iatrogenic peripheral nerve injuries that require special attention. The postoperative algorithm approaches can be effective, but the waiting and treatment processes can be long and painful. Preventive measures are undoubtedly more effective than postoperative remedies. The best means of preventing disease is having a good understanding of anatomy and conducting a careful dissection.

5. Woodgate, C. J. (2018). "Managing neuropathic pain after surgery." Pain Management Today: 72.

6. Chapman, C. R. and C. J. Vierck (2017). "The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms." The Journal of Pain 18(4): 359.e351-359.e338.

   The nature of the transition from acute to chronic pain still eludes explanation, but chronic pain resulting from surgery provides a natural experiment that invites clinical epidemiological investigation and basic scientific inquiry into the mechanisms of this transition. The primary purpose of this article is to review current knowledge and hypotheses on the transition from acute to persistent postsurgical pain, summarizing literature on clinical epidemiological studies of persistent postsurgical pain development, as well as basic neurophysiological studies targeting mechanisms in the periphery, spinal cord, and brain. The second purpose of this article is to integrate theory, information, and causal reasoning in these areas. Conceptual mapping reveals 5 classes of hypotheses pertaining to pain. These propose that chronic pain results from: 1) persistent noxious signaling in the periphery; 2) enduring maladaptive neuroplastic changes at the spinal dorsal horn and/or higher central nervous system structures reflecting a multiplicity of factors, including peripherally released neurotrophic factors and interactions between neurons and microglia; 3) compromised inhibitory modulation of noxious signaling in medullary-spinal pathways; 4) descending facilitatory modulation; and 5) maladaptive brain remodeling in function, structure, and connectivity. The third purpose of this article is to identify barriers to progress and review opportunities for advancing the field. This review reveals a need for a concerted, strategic effort toward integrating clinical epidemiology, basic science research, and current theory about pain mechanisms to hasten progress toward understanding, managing, and preventing persistent postsurgical pain. Perspective The development of chronic pain after surgery is a major clinical problem that provides an opportunity to study the transition from acute to chronic pain at epidemiologic and basic science levels. Strategic, coordinated, multidisciplinary research efforts targeting mechanisms of pain chronification can to help minimize or eliminate persistent postsurgical pain.

7. Tsai, H. J., et al. (2009). "Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study." Supportive Care in Cancer 17(11): 1353-1360.

   GOALS OF WORK: The purpose of this study is to compare the treatment and retention effects between standard decongestive lymphatic therapy (DLT) combined with pneumatic compression (PC) and modified DLT, in which the use of a short-stretch bandage is replaced with the use of Kinesio tape (K-tape) combined with PC.

   MATERIALS AND METHODS: Forty-one patients with unilateral breast-cancer-related lymphedema for at least 3 months were randomly grouped into the DLT group (bandage group, N = 21) or the modified DLT group (K-tape group, N = 20). Skin care, 30-min manual lymphatic drainage, 1-h pneumatic compression therapy, application of a short-stretch bandage or K-tape for each group, and a 20-min physical therapy exercise were given during every treatment session. Patient evaluation items included physical therapy assessment, limb size, water composition of the upper extremity, lymphedema-related symptoms, quality of life, and patients' acceptance to the bandage or tape.

   MAIN RESULTS: There was no significant difference between groups in all outcome variables (P > 0.05) through the whole study period. Excess limb size (circumference and water displacement) and excess water composition were reduced significantly in the bandage group; excess circumference and excess water composition were reduced significantly in the tape group. The acceptance of K-tape was better than the bandage, and benefits included longer wearing time, less difficulty in usage, and increased comfort and convenience (P < 0.05).

   CONCLUSIONS: The study results suggest that K-tape could replace the bandage in DLT, and it could be an alternative choice for the breast-cancer-related lymphedema patient with poor short-stretch bandage compliance after 1-month intervention. If the intervention period was prolonged, we might get different conclusion. Moreover, these two treatment protocols are inefficient and cost time in application. More efficient treatment protocol is needed for clinical practice.

8. Shim, J. Y., et al. (2003). "The use of elastic adhesive tape to promote lymphatic flow in the rabbit hind leg." Yonsei Medical Journal 44(6): 1045-1052.

   Any method that deforms the skin of the extremities may increase lymphatic flow rate, and may be applied to treat peripheral lymphedema. This study was undertaken to investigate whether or not elastic adhesive tape with passive exercise can increase lymph flow in the rabbit hind leg by effective and periodic skin deformation. Cannulation into a pre-popliteal afferent lymphatic vessel in the lower left leg of 22 male New Zealand White rabbits was performed under a stereomicroscope. After stabilization, lymph was collected at rest or during passive exercise with an electric motor at 60 r.p.m. for 15 minutes and was then measured. Lymph flow rate was calculated and expressed as g/hour. Increase of lymph flow rate due to taping was significant only for passive exercise (p=0.0317). The lymph flow rate increased linearly as the area of tape was increased (p=0.0011), and lymph flow rates were significantly different according to site (p=0.0017). Tape on the anterior aspect of the ankle caused salient deformation and tended to increase the lymph flow rate more so than tape on the dorsum of the foot (p=0.0831). Taping with elastic adhesive tape in passive exercise increased the lymph flow rate in the rabbit hind leg by deforming the skin, which suggests a novel therapeutic method in cases of peripheral lymphedema.

9. Bosman, J. (2014). "Lymphtaping for lymphoedema: an overview of the treatment and its uses." British Journal of Community Nursing 19(Sup4): S12-S18.

   Lymphtaping is recognised to be a promising method for use in the management of lymphoedema. This article gives an overview of the concept of lymphtaping and the relevant literature. Several methods of action are described about lymphtaping: increasing pressure differences within lymph vessels; lifting the skin (inducing opening of initial lymph vessels); connective tissue becoming more flexible; and the micromassage effect. Medical taping concepts have only become the subject of scientific research in the last decade as the technique is still relatively new. Several misunderstandings around lymphtaping therefore still exist. These are discussed, supported by the available evidence. The article demonstrates that lymphtaping is a promising technique in the treatment of lymphoedema, and should be another choice for contraindicating pressure therapy patients and in areas where compression is difficult or impossible to use. However, each patient should be assessed and evaluated thoroughly and individually so that the appropriate treatment and properties can be determined