Pain Control After Surgery

What is pain?

Pain is an uncomfortable feeling that tells you something may be wrong in your body. Pain is your body’s way of sending a warning to your brain. Your spinal cord and nerves provide a pathway for pain messages to travel to and from your brain and the other parts of your body.

Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells, most sense pain and the fewest sense cold. When there is an injury to your body—in this case surgery—these tiny cells send messages along nerves into your spinal cord and then up to your brain. Pain medicine blocks these pain messages or reduces their effect on your brain.

Sometimes pain may be just a nuisance, like a mild headache. At other times, such as after a surgery, pain that doesn’t go away—even after you take pain medicine—may be a warning sign that there is a problem. After your surgery, your nurses and doctors will ask you about your pain because they want you to be comfortable, but also because they want to know if something is wrong. Be sure to tell your doctors and nurses when you have pain and how much pain you are having.

Treatment Goals

People used to think that severe pain after surgery was something they “just had to put up with.” But with current pain treatments, that’s no longer true. Today, you can work with your nurses and doctors before and after surgery to prevent or relieve pain.

Pain control can help you:

  • Enjoy more comfort while you heal.
  • Get well faster. With less pain, you can start walking, do your breathing exercises, and get your strength back more quickly. You may even leave the hospital sooner.
  • Improve your results. People whose pain is well-controlled seem to do better after surgery. They may avoid some problems (such as pneumonia and blood clots) that affect others.

What are your pain control options?

Both drug and non-drug treatments can be successful in helping to prevent and control pain. The most common ways of controlling pain control are talked about below. You and your doctors and nurses will decide which methods are right for you. Many people use two or more methods to get greater relief.

Don’t worry about getting “hooked” on pain medicines. Studies show that this is very rare—unless you already have a problem with drug abuse.

What can you do to help keep your pain under control?

These seven steps can help you help yourself.

Before surgery

1. Ask the doctor (surgeon or anesthesiologist) or nurse what to expect.

  • Will I have a lot of pain after surgery?
  • Where will the pain be?
  • How long is the pain likely to last?

Being ready for pain helps put you in control. You may want to write down your questions before you talk with your doctor or nurse. There is a pain control plan at the bottom of this page.

2. Discuss the pain control options with your doctors and nurses. Be sure to:

  • Talk with them about pain control methods that have worked well or not so well for you before (If you have had surgery before, tell them what worked and what didn’t.).
  • Talk with them about any concerns you may have about pain medicine such a side effects.
  • Tell them about any allergies to medicines you may have.
  • Ask about side effects that may occur with treatment.
  • Talk with them about all medicines you take for other health problems. The doctors and nurses need to know, because mixing certain drugs with some pain medicines can cause problems.

3. Talk about the schedule for receiving pain medicines in the hospital. Some people get pain medicines in the hospital only when they ask for it. Sometimes there are delays, and the pain gets worse while they wait. There are other ways to schedule pain medicine which seems to give better results.

  • Giving the pain pills or shots at set times. Instead of waiting until pain breaks through, you receive medicine at set times to keep the pain under control.
  • Patient controlled analgesia (PCA). With PCA, you control when you get pain medicine. When you begin to feel pain, you press a button to inject the medicine through the intravenous (IV) tube in your vein.

Your nurses and doctors will ask you how the pain medicine is working and can change the medicine, its dose (how much you are getting), or its timing (when you are getting it) if you are still having pain.

4. Work with your doctors and nurses to make a pain control plan. You can use the pain control form at the bottom of this to begin planning for pain control so you will feel confident you won’t be in pain after surgery. Your doctors and nurses need your help to design the best plan for you. When your pain control plan is complete, use the form to write down what is expected to happen. Refer to it after your operation and keep good records. Then keep this plan as a record if you need surgery in the future you will know what works for you.

Pain Control After Surgery

5. Take (or ask for) pain relief medicine when pain first begins.

  • Take action as soon as the pain starts. It is harder to stop the pain once it starts.
  • If you know your pain will get worse when you start walking or doing breathing exercises, take pain medicine first. It’s harder to ease pain once it has taken hold. This is a key step in proper pain control.
  • Let your health care team know about pain methods that have worked for you in the past.
  • Let them know what makes your pain better or worse.
  • Tell them where you hurt and how much.

If you had general anesthesia, as you are waking up, let your nurse know if  you need pain medicine, you feel sick to your stomach, or if parts of your body feel numb or tingle.

6. Help the doctors and nurses “measure” your pain.

  • Everyone feels pain differently. They may ask you to use a “pain scale.” A pain scale can be pictures or ask you how bad you are hurting.
  • They may ask you to rate your pain on a scale of 0 to 10. Or you may choose a word from a list that best describes the pain.
  • You may also set a pain control goal (such as having no pain that’s worse than 2 on the scale).
  • Reporting your pain as a number helps the doctors and nurses know how well your treatment is working and whether to make any changes in your pain control plan.

7. Tell the doctor or nurse about any pain that won’t go away.

  • Don’t worry about being a “bother” to the nurses. Controlling your pain is important for your healing.
  • Pain can be a sign of problems with your surgery.
  • The nurses and doctors want and need to know about pain that can’t be controlled.

Stick with your pain control plan if it’s working. Your doctors and nurses can change the plan if your pain is not under control. Let the nurses and doctors know about your pain and how the pain control plan is working.

Benefits and Risks of Pain Treatment Methods

This information is provided to help you talk about your pain control options. Sometimes it is best to combine two or more methods or change the treatments slightly to meet your needs. Your doctors and nurses will talk with you about your options. The benefits of controlling your pain is that you will better be able to heal and you can get back to your normal routine quicker. Keep in mind that your pain will get better each day.

Pain Relief Medicines

Tell the nurse if you feel sick after taking pain medicine, or if you just don’t feel right. Your doctor may order a different medicine for you.

Nonsteroidal anti-inflammatory drugs (NSAIDS)

Acetaminophen (such as, Tylenol), aspirin, ibuprofen (such as, Motrin), and other NSAIDs reduce swelling and soreness and relieve mild to moderate pain.

Benefits

There is no risk of addiction to these medicines. Depending on how much pain you have, these medicines can lessen or eliminate the need for stronger medicines (such as, morphine or another opioid). Most NSAIDs interfere with blood clotting.

Risks

They may cause nausea, stomach bleeding, or kidney problems. For severe pain, an opioid usually must be added.

Opioids

Morphine, codeine, and other opioids are most often used for acute pain, such as short-term pain after surgery.

Benefits

These medicines are effective for severe pain, and they do not cause bleeding in the stomach or elsewhere. It is rare for a patient to become addicted as a result of taking opioids for pain after surgery.

Risks

Opioids may cause drowsiness, nausea, constipation,

Local anesthetics

These medicines (such as, bupivacaine) are given, either near the incision or through a small tube in your back, to block the nerves that send pain signals.

Benefits

Local anesthetics are effective for severe pain. Injections at the incision site block pain from that site. There is little or no risk of drowsiness, constipation, or breathing problems. Local anesthetics reduce the need for opioid use.

Risks

Repeated injections are needed to maintain pain relief. An overdose of local anesthetic can have serious consequences. Average doses may cause some patients to have weakness in their legs or dizziness.

Ways to Give Pain Relief Medicines

Tablet or liquid

Medicines given by mouth (such as, aspirin, ibuprofen, or opioid medications such as codeine).

Benefits

Tablets and liquids cause less discomfort than injections into muscle or skin, but they can work just as well. They are inexpensive, simple to give, and easy to use at home. Being able to control pain by taking pills or liquids is usually one of the conditions before you go can home from the hospital.

Risks

These medicines cannot be used if nothing can be taken by mouth or if you are nauseated or vomiting; sometimes these medicines can be given rectally (suppository form). There may be a delay in pain relief, since you must ask for the medicine and wait for it to be brought to you; also, these medicines take time to wear off.

Injections into skin or muscle

Medicine given by injection into skin or muscle is effective even if you are nauseated or vomiting; such injections are simple to give.

Benefits

The injection site is usually painful for a short time.

Risks

Medicines given by injection are more expensive than tablets or liquids and take time to wear off. Pain relief may be delayed while you ask the nurse for medicine and wait for the shot to be drawn up and given.

Injections into vein

Pain relief medicines are injected into a vein through a small tube, called an intravenous (IV) catheter. The tip of the tube stays in the vein.

Benefits

Medicines given by injection into a vein are fully absorbed and act quickly. This method is well suited for relief of brief episodes of pain. When a patient controlled analgesia (PCA) pump is used, you can control your own doses of pain medicine.

Risks

A small tube must be inserted in a vein. If PCA is used, there are extra costs for pumps, supplies, and staff training. You must want to use the pump and learn how and when to give yourself doses of medicine.

Non-drug Pain Relief Methods

These methods can be effective for mild to moderate pain and to boost the pain-relief effects of drugs. There are no side effects. These techniques are best learned before surgery.

Patient teaching

Learning about the operation and the pain expected afterwards (for example, when coughing or getting out of bed or a chair).

Benefits

These techniques can reduce anxiety; they are simple to learn, and no equipment is needed.

Risks

There are no risks; however, patient attention and cooperation with staff are required.

Relaxation

Simple techniques, such as abdominal breathing and jaw relaxation, can help to increase your comfort after surgery.

Benefits

Relaxation techniques are easy to learn, and they can help to reduce anxiety. After instruction, you can use relaxation at any time. No equipment is needed.

Risks

There are no risks, but you will need instruction from your nurse or doctor.

Physical agents

Ice packs, massage, rest, and TENS therapy are some of the non-drug pain relief methods that might be used following surgery.

Benefits

In general, physical agents are safe and have no side effects. TENS, which stands for transcutaneous electrical nerve stimulation, is often helpful; it is quick to act and can be controlled by the patient.

Risks

There are no risks related to the use of physical techniques for managing pain. If TENS is used, there is some cost and staff time involved for purchasing the machine and instructing patients in its use. Also, there is only limited evidence to support the effectiveness of TENS for pain relief in certain situations.

Keeping A Pain Control Record

Pain control plan for

_______________________________________________________________________________
Your name

Before surgery, I will take

_______________________________________________________________________________
Name of medicine

How I will use the medicine

_______________________________________________________________________________

_______________________________________________________________________________

After surgery, I will take in the hospital.

________________________________________________________________________________
Name of medicine

The medicine will be given to me:

__________as a pill

__________through a vein

__________as a shot

_________through a tube in my back.

I will receive the medicine:

__________at certain times

__________every__________hours for_________ days:

__________around the clock

__________when I call the nurse.

I will also use these non-drug pain control methods in the hospital and at home (list methods):

_________________________________________________________________________________

_________________________________________________________________________________

At home, I will take

_________________________________________________________________________________
Name of medicine

How I will use the medicine at home

_________________________________________________________________________________

_________________________________________________________________________________

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