Medical Edge Newspaper Column

After The Operation, Holistic Pain Control

Oct. 22, 2006
DEAR MAYO CLINIC:
Does Mayo Clinic prescribe nontraditional medicine such as massage or acupuncture for post-surgical pain and relief? -- Texas

ANSWER:
Mayo Clinic is using these and other nontraditional approaches. Some call them alternative methods, though I prefer the term "complementary" because they work so well in conjunction with, rather than in replacement of, the excellent medical options already in standard use. Over the past several years, our cardiac surgery division has developed a healing enhancement program aimed at minimizing post-surgical pain. It does so by combining the administration of drugs with attention to the patient's physical, environmental, emotional and spiritual needs.

For example, post-surgical cardiac patients often report severe back pain, which actually derives not from the surgery itself but from muscle strain caused by positioning on the operating table. We find that using therapeutic massage reduces pain, which improves a patient's comfort level and lessens anxiety, leading to further pain reduction. While standard analgesic drugs should be used as well, we find that the complementary methods allow us to significantly reduce the amount of drug that a patient needs.

The program also includes elements such as music therapy and guided imagery -- akin to meditation -- that produce similar results. These techniques were adopted after careful scientific study convinced us that they worked. We have also introduced acupuncture and acupressure, and are currently studying their effectiveness in easing post-surgical discomfort.

Taking only the traditional clinical measures, while necessary, is no longer sufficient. I am a traditionalist in many regards, but I also recognize the need to go beyond our traditional way of thinking to provide the best care for the whole patient. While a typical operation lasts only a few hours (during which time the patient, anesthetized and usually unconscious, feels no pain), it's the much longer and often-painful aftermath that my colleagues and I are increasingly focusing on. We need to ensure that people don't hurt unnecessarily or feel out of control. If people feel comfortable -- more "at home" and in some control of their situation -- they will return to a well state faster, which is our aim after all.

Meanwhile, we are certainly not abandoning the traditional options. Opioid analgesics such as morphine and codeine, acetaminophen (Tylenol), combinations of acetaminophen and opioids (Vicodin, Percocet), nonsteroidal anti-inflammatory drugs like ibuprofen (Advil) and local anesthetics typically play an important role in post-surgical pain control. But even here, patients can retain some responsibility through patient-controlled analgesia, by which programmed pump devices allow the individual to self-administer medication without risking overdose or addiction.

Finally, it's worth noting that some patients actually decline pain-management methods, whether traditional or nontraditional, under the erroneous assumption of "no pain, no gain." Scientific studies show the opposite: people who employ pain-control options early and aggressively do much better than those who do not. Improved post-operative comfort aids healing and allows patients to be more active, gain strength sooner, recover faster and experience fewer complications.

The period after surgery will never be painless, but we all should take advantage of both traditional and proven complementary methods while participating as informed and active partners in the healing process.

-- Thoralf M. Sundt III, M.D., Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.