Pain medications after surgery

Severe pain after surgery can typically be successfully treated. Modern pain medications and anesthesia can control post-surgical pain and help your body heal.

By Mayo Clinic Staff

If you're having surgery, it's natural to have concerns about pain after the procedure, as well as the risks associated with powerful pain medications. Controlling pain and minimizing side effects are both important for post-surgical comfort, recovery and rehabilitation.

The time to talk about post-surgical pain relief and pain medications is before you have surgery. Being prepared can lead to more effective pain management.

Planning for surgery

Before surgery you will likely have a discussion with your surgeon or other members of your care team about pain management, treatment options and your particular needs. This conversation may include the following ideas:

  • Pain expectations. Ask your doctor about pain typically associated with the procedure and the expected duration of recovery.
  • Previous experiences with pain. Talk to your doctor about your experience with pain and different methods of pain control. Mention what has worked for you and what hasn't in the past.
  • Chronic pain. If you take drugs to treat chronic pain, your body may be less sensitive to pain medication. Your doctor will discuss options for treating both chronic pain and post-surgical pain.
  • List of your medications. Include all prescription and over-the-counter medications, plus any supplements or herbs you've taken in the past month. Your doctor needs to know about anything that might interact with post-surgical pain medications. You may need to change your drug regimen before and after surgery.
  • Alcohol and drug use. Accurately describe your current use of alcohol, tobacco or illicit drugs. Your doctor needs to know if you are recovering from addiction to — or currently abuse — alcohol or drugs, including prescription medications, in order to plan and monitor your pain management.
  • Side effects. Ask for written information about the drugs you will be prescribed and their side effects. Ask questions about what can be done to minimize side effects and when to get help for serious side effects.
  • Additional pain management. Ask your doctor about interventions that may support your treatment plan, such as psychobehavioral interventions to address anxiety or coping skills.
  • Discussion of your concerns. If you're afraid of side effects or overdosing on pain medications, talk to your doctor. He or she can help you understand strategies to safely manage your pain.

Types of pain medication

Post-surgical pain is usually managed with multiple pain-reducing medications (analgesics). The appropriate type, delivery and dose of medications for you depend on the type of surgery and expected recovery, as well as your own needs.

Pain medications include the following:

  • Opioids, powerful pain medications that diminish the perception of pain, include fentanyl, hydromorphone, morphine, oxycodone, oxymorphone and tramadol. Examples of opioids prescribed in pill form after surgery include oxycodone (Oxycontin, Roxicodone, others) and oxycodone with acetaminophen (Percocet, Roxicet, others).
  • Local anesthetics, such as lidocaine and bupivacaine, cause a short-term loss of sensation at a particular area of the body.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, Anaprox, others), celecoxib (Celebrex) or ketorolac — lessen the inflammatory activity that exacerbates pain.
  • Other nonopioid pain relievers include acetaminophen (Tylenol, others) and ketamine (Ketalar).
  • Other psychoactive drugs that may be used for treating post-surgical pain include the anti-anxiety medication midazolam or the anticonvulsants gabapentin (Gralise, Horizant, Neurontin) and pregabalin (Lyrica).

Your surgeon will likely prescribe a combination of treatments to control pain, lessen side effects, enable you to resume activity appropriate for recovery and lower risks associated with opioids.

Managing the risks of opioid use

Opioids are critical for post-surgical pain management because of the drug's powerful effect. But side effects can be significant, including nausea, vomiting, constipation, urinary retention, drowsiness, impaired thinking skills and poor respiratory function.

Overdosing and abuse of opioids also are risks, particularly when opioids are used to treat ongoing (chronic) pain. While the use of opioids after surgery is intended as a short-term strategy to relieve pain while the body heals, the risk of abuse is still a concern.

The U.S. surgeon general launched an initiative in 2016 to address the growing problem of opioid overdose and misuse. The program has initiatives for doctors to educate their patients, screen and regularly reassess for misuse of opioids, assess pain management regularly, use nonopioid drugs when possible, and treat addiction.

The program also provides strategies to help you lessen risks for yourself, as well as others:

  • Taking medication only as directed, minimizing dosage and duration of opioid use
  • Talking to your doctor when your pain is not under control
  • Not using alcohol while taking opioids
  • Following your doctor's instructions about other drugs not to take while using opioids
  • Storing drugs safely
  • Disposing of unused drugs, ideally through a pharmacy take-back program
  • Not sharing your medication with other people
June 30, 2017