Desensitisation programme

Desensitisation Programme

Patient Information

MSK Outpatients

• Author ID:            Daniela Alba  
• Leaflet Ref:           Musc 082
• Version:               1  
• Leaflet Title:         Desensitisation Programme
• Last Review:        27/06/2023
• Expiry Date:         27/06/2026

Introduction

Scar formation is a normal response following an injury or surgery. An active scar can become thick, firm and raised and sometimes become ‘over-sensitive’ to touch, temperature and textures. It can also limit motion and function. The symptoms can be unpleasant, and it can take time for this sensitivity to reduce and the sensation to normalise. 

To reduce this over-sensitivity, the nerve endings need to be “re-trained” to distinguish between different types of sensation. Your desensitisation programme aims to educate the nerve endings with a range of sensations. The outcome is directly linked to how often you complete the programme. It is recommended that you complete the programme three to four times a day, where relevant.

Completing the desensitisation programme:

1) Scar Massage:

• Use a small amount of emollient cream (e.g. E45) or natural oil (e.g. olive oil) and massage the affected area for approximately five minutes. 
• Massage in small circular movements with your thumb or finger pressed down along the scar; firm enough to make the end of your nail white.
• Do not drag the skin being massaged as this will cause friction, making the skin fragile and sore.
• Massage should be completed three to four times daily, washing the area prior to re-application of the cream. 

2) Silicone Gel:

• Silicone can help to improve the colour, height and texture of a scar and may also relieve discomfort.
• Silicone gel can be placed on the scar in sheets or liquid form and can be purchased at your local pharmacy or over the internet. Mepiform and CICA-care silicone dressings are used by the trust. 
• They are comfortable and easy to use and can usually be washed or re-used.
• Make sure the skin is clean and dry and free from any oils etc. Apply the silicone over the scar and keep in place throughout the day/night as tolerable. Speak to your therapist for time advised to wear.
• Clean the skin/scar between each application.

3) Textured Massage:

• Following discussion with your therapist select five different grades of textures/fabrics that range from smooth (silk), medium (cotton), rough (velcro), to coarse (scouring pad).
• Rank these in order of most bearable, to unpleasant, to intolerable
• Using the most tolerable texture, first make small gentle circles over the scar until this feels comfortable and easy. Do this continuously for 2-3 minutes.
• Select the next grade-up of fabric and repeat the massage; if this feels uncomfortable continue with the massage until it becomes more bearable. 
• Should the sensation from the massage become intolerable return to the grade below and continue until comfortable again.
• Progress through each of the grades of fabric, using this technique until the most unbearable becomes easy to tolerate

4) Tapping and Vibration: 

• Gently tap the area around the scar. As the sensation becomes more tolerable, tap directly over the scar. Continue for up to five minutes.
• Vibration can also be effective at desensitising skin, using a device such as an electric toothbrush or shaver. Using the ‘base’ of the device, switch on and apply to the skin adjacent to the scar. As the sensation becomes more tolerable place the device over the scar itself. Continue for up to 5 minutes. 
• Should the sensation from the tapping or vibration become intolerable return to the area around the scar and continue until comfortable again

5) Temperature:

• Hot or cold packs can be useful for pain relief and to reduce sensitivity. Apply for up to 10 minutes at one time. Ensure to test the area with normal skin before applying to avoid injury or burns.
• Having a bath or shower. Select a water temperature that you can tolerate to begin with and increase to warmer/cooler as tolerable. 
• Hydrotherapy (exercise in water) can also be useful. Speak to your clinician/physiotherapist or visit your local pool.6.

6) Function:

• It is important to use your limb during your daily activities. This not only helps desensitise the scar, but increases your function, helping you get back to normality. 
• Pick activities that might increase sensitivity such as writing, washing up, cleaning (for upper limb) and walking, swimming, cycling (for lower limb) and gently increase the amount of time you are able to complete these activities.
• If at any point the sensation becomes intolerable, stop and wait for the sensation to settle before trying again.

If your symptoms are not improving or you have any concerns, please contact one of the following: 

Wrightington Outpatient Physiotherapy: 01942 822109

Wrightington Outpatients: 01942 822103 

Wrightington Hand Unit: 01257 488272