Is it normal for pain to increase after surgery?

September 22, 2025 •

5 min read

According to research published by the National Institutes of Health, between 10% and 50% of patients who undergo common surgical procedures experience persistent or intermittent pain well after the initial recovery period. This pain is not always a linear, downward trend, and many people experience a temporary increase in discomfort during their healing process. So, is it normal for pain to increase after surgery?

Quick Summary

An increase in pain after surgery can be a normal part of the healing process, especially a few days after the procedure as anesthetic effects wear off and inflammation peaks. However, sudden or severe pain, accompanied by other symptoms like fever or swelling, could indicate a complication. The type of surgery, individual pain tolerance, and how you manage your recovery can all influence your pain levels.

Key Points

Initial Pain Spike: An increase in pain a few days after surgery is often a normal occurrence as the initial anesthetic effects subside.
Inflammatory Response Peaks: The body's natural inflammatory process typically peaks within the first few days post-surgery, leading to increased pain and swelling.
Overexertion Risk: Increasing activity levels too quickly during recovery can cause inflammation and a temporary increase in pain; listen to your body and medical advice to avoid this.
Neuropathic Pain: Nerve healing after surgery can sometimes cause a different kind of pain, such as burning or tingling, which can emerge weeks or months later.
Scar Tissue Formation: As the incision heals, the formation of scar tissue can sometimes constrict nerves or tissues, leading to a persistent pulling sensation or ache.
Monitor for Complications: While pain can fluctuate, persistent, severe, or sudden increases in pain accompanied by fever, chills, or spreading redness should prompt a call to your doctor.
Effective Pain Management: Staying consistent with your prescribed pain medication schedule, rather than waiting for severe pain, is a key strategy for managing discomfort during recovery.

Understanding the Post-Surgical Pain Curve

After surgery, most patients are given pain medication that is very effective in the first 24 to 48 hours. As the effects of this medication, including any regional anesthesia, begin to wear off, it is common to feel a spike in pain. This initial rebound in pain can be startling but is typically a normal part of recovery. The body’s inflammatory response is also at its peak during the first few days, contributing to this heightened sensation of pain.

Why Pain Can Increase During Recovery

The Inflammatory Response

Surgery is a form of trauma to the body, and the inflammatory response is your body's natural defense mechanism. While it's a necessary part of healing, it also causes pain, swelling, and redness. The severity of inflammation and when it peaks can vary based on the type of surgery and your individual health. Typically, inflammation and the associated pain will be most noticeable a few days after the procedure, not immediately after, because of residual anesthetics.

Activity Levels and Movement

As you feel better, it's natural to want to increase your activity. However, overexerting yourself too early can lead to a flare-up of pain. For example, a person recovering from a knee replacement might feel great after a few days and decide to walk more than recommended. This can put stress on the surgical site, causing increased inflammation and pain. It's crucial to follow your doctor’s and physical therapist's instructions regarding movement and weight-bearing exercises.

The Role of Nerve Healing

Nerves are often cut or stretched during surgery, and their healing process can be unpredictable. As nerves regenerate, they can send abnormal or heightened pain signals. This type of neuropathic pain can feel different from the initial surgical pain; patients often describe it as burning, shooting, or tingling. This can be a late-stage increase in pain, appearing weeks or months after the surgery itself.

Scar Tissue Formation

As the body forms new tissue to repair the incision, scar tissue develops. In some cases, excessive or tight scar tissue can press on surrounding nerves and tissues, causing a new source of pain. This pain may feel like tightness, pulling, or a persistent dull ache. Techniques such as massage and physical therapy are often used to manage scar tissue and prevent it from causing chronic pain.

Normal vs. Concerning Pain: A Comparison

It's important for patients to distinguish between expected pain fluctuations and a sign of a serious issue. Knowing when to contact your doctor can prevent complications.


Characteristic	Normal Pain Fluctuation	Concerning Pain (Potential Complication)
Onset	Gradual increase a few days after surgery, often following a change in medication or activity.	Sudden, severe, and sharp increase in pain, often accompanied by other symptoms.
Sensation	Dull, throbbing, or aching; improves with rest and medication.	Intense, stabbing, burning, or shooting pain; may not be relieved by prescribed medication.
Swelling	Mild to moderate swelling around the surgical site, gradually decreasing over time.	Significant, rapid, and disproportionate swelling, especially if it spreads or is accompanied by warmth.
Other Symptoms	Generally absent, or mild and manageable (e.g., fatigue).	Fever, chills, green/yellow discharge from the wound, spreading redness, foul odor, or difficulty breathing.
Duration	Peaks and then gradually subsides over days or weeks.	Persistent and worsening, or lasting longer than the expected recovery timeline.

Factors Influencing Post-Surgical Pain

Several factors can influence the intensity and duration of post-surgical pain, affecting why some patients feel an increase while others do not.

Type of Surgery: Procedures that involve deep tissue manipulation, nerve involvement, or bone work (like orthopedic surgery) often cause more significant and prolonged pain. A minimally invasive laparoscopic procedure, for example, typically results in less pain than an open abdominal surgery.
Individual Pain Tolerance: Each person's brain interprets pain signals differently. A person's personal pain threshold and psychological state, including pre-existing anxiety, can influence their postsurgical pain experience.
Chronic Pre-Surgical Pain: Patients who experienced chronic pain before their surgery are at a higher risk of persistent postoperative pain. The body's pain pathways may already be sensitized, making the recovery period more difficult.
Pain Management Plan: An effective and consistent pain management plan is crucial. Taking medication as prescribed and not waiting until the pain is severe makes a significant difference. Multimodal analgesia, which combines different types of pain relievers, is often used to manage pain more effectively.

Actionable Steps for Patients

Communicate with your doctor: Don't hesitate to contact your healthcare provider if you are concerned about your pain level. Describing the type and location of your pain can help them determine if it's normal or if a complication is developing.
Stick to your pain management schedule: Follow your doctor's instructions for taking pain medication. Consistent medication use can keep pain from escalating to an unmanageable level. Combining prescribed and over-the-counter options (if approved by your doctor) can also be highly effective.
Manage your activity: Balance rest with appropriate movement. Physical therapy and gentle walking are often key to a good recovery, but know your limits. Avoid overdoing it, which can cause inflammation and a pain increase.
Try non-pharmacological methods: Applying ice packs to the surgical site can reduce inflammation and numb the area, providing relief. Relaxation techniques, mindful breathing, and distraction can also help manage discomfort. For more information on managing chronic pain, consult reputable sources like the American Chronic Pain Association [http://www.theacpa.org/].
Monitor for signs of infection: Be vigilant for signs of infection, which can cause significant and worsening pain. These include increased warmth, redness, pus, or a fever.

Conclusion

An increase in pain after surgery can be a normal and expected part of the healing journey. Often, it's due to the wearing off of initial anesthetics, the body's natural inflammatory response peaking, or an increase in activity during recovery. While these experiences are common, it is essential to be able to recognize the difference between a normal fluctuation and a potential complication. By following your doctor's guidance, managing your activity, and staying attentive to your body's signals, you can navigate your recovery with confidence and ensure a smooth healing process.

Frequently Asked Questions

Yes, it is very common for pain to increase around day three after surgery. This is often because the strongest pain medications administered in the hospital are beginning to wear off, and the body's natural inflammatory response to the surgical trauma is reaching its peak. Rest, proper medication, and following your doctor's instructions for icing can help manage this.

Pain typically peaks within the first week after surgery, often between days 3 and 7. The exact timing and severity depend on the type of procedure, individual factors, and how effectively pain is being managed.

A worrying increase in pain is one that is sudden, severe, and not relieved by medication. It becomes more concerning if accompanied by other symptoms like a high fever, chills, spreading redness, pus draining from the incision, or a foul odor. These could be signs of a complication, such as an infection.

Yes, increasing your activity level too quickly or overexerting yourself can cause pain to increase after surgery. Movement is important for recovery, but it must be balanced with rest. Listen to your body and follow the specific guidelines given by your surgeon or physical therapist.

If your pain increases, first ensure you are taking your medication as prescribed. You can also try applying ice packs to the surgical area to reduce swelling and inflammation, and practice relaxation techniques. If the pain is severe or accompanied by other worrying symptoms, contact your doctor immediately.

Normal postsurgical pain is typically described as a dull ache or throbbing sensation. Nerve pain, or neuropathic pain, often feels more like shooting, burning, or tingling sensations. Nerve pain can also emerge later in the recovery process as nerves begin to heal or become entrapped by scar tissue.

Yes, it is common for postsurgical pain to feel worse at night. This can be due to a variety of factors, including reduced distractions, changes in body position, and the sleep disruptions often caused by pain medication. Establishing a consistent bedtime routine and managing pain effectively before sleep can help.

Most patients experience a significant reduction in pain over time, with many returning to a pain-free state. However, some individuals may experience persistent or chronic pain lasting months or even years, especially in cases of major surgery, nerve damage, or pre-existing chronic pain.