You don't have to endure severe pain after surgery. 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 — or even fears — about the pain following the procedure. Some pain is common after surgery, but you shouldn't have to endure severe pain. Pain medications are a key part of your recovery. Well-controlled pain using pain medications can speed healing and lead to fewer complications.
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.
Here's how to start:
- Discuss previous experiences with pain. Before surgery, talk to your doctor about your experience with different methods of pain control. Mention what worked for you and what didn't.
- Talk about chronic pain. If you have chronic pain, you'll likely have to deal with that pain in addition to the post-surgical pain. And your body may be less sensitive to pain medication — a phenomenon called tolerance — if you're taking medications for chronic pain. Discuss this in detail with your doctor before surgery.
- Make a 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.
Be honest about your alcohol and drug use. Tell your doctor if you're a recovering alcoholic or have a history of other addiction. If so, you can plan for pain control that minimizes the risk of relapse.
If you're currently misusing alcohol or drugs — even those that have been prescribed for you — let your doctor know. Withdrawing from these substances can be difficult, and the post-surgical period is not the time to try it.
- Ask questions. Find out how severe the pain typically is after this type of surgery, and how long it lasts. What kind of pain medications will be given before and after surgery? What are the possible side effects of these medications? What can be done to minimize side effects?
- Discuss your concerns about pain medications. 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, such as combining medications or using patient-controlled analgesia — a system that allows you to give yourself a dose of pain medication by pushing a button.
Post-surgical pain control requires balancing benefits and risks. If your pain medications are too strong, you may have side effects, such as sleepiness, nausea or vomiting. But if pain medications are too weak, you may experience unnecessary pain.
Pain limits your ability to breathe deeply, cough, walk and perform the activities necessary for a speedy recovery. The goal is finding the right balance for you at each point during and after the procedure.
Doctors often rely on intravenous medications to relieve pain during and immediately after surgery. These techniques are typically used until you're able to take pain medications by mouth. The type of pain medication you receive may depend partially on the type of surgery you have because the intensity of pain and the effectiveness of certain drugs varies by surgery.
Intravenous (IV) pain medication
Before surgery, you'll probably have a slender plastic tube (catheter) inserted into a vein in your hand or arm to give you fluids, sedatives, anesthetics, antibiotics or pain medications. After surgery, your doctor may keep this IV catheter in place to deliver pain medication while you're in the hospital or outpatient recovery area.
Pain relievers, such as opioids (for example, morphine or fentanyl), are usually injected into your IV catheter at regular intervals. Most hospitals also offer patient-controlled analgesia (PCA) — a system that allows you to give yourself a fixed dose of the medication by pushing a button. This way you don't have to ask a nurse for each dose of pain medicine.
The PCA system has built-in safeguards to prevent you from overdosing on pain medication. If you push the button more than once within a set period of time, the dispenser ignores the second request. This gives each dose of pain medicine enough time to work before you receive another dose.
When there's more medication than you need in your bloodstream, you become too sleepy to press the button. When you're no longer drowsy from medication, you'll be able to safely give yourself another dose.
That's why friends or family should never push your PCA button. No one but the person receiving the medication should ever administer a dose.
In epidural analgesia, pain medications are injected through a catheter inserted into the epidural space within your spinal canal but outside your spinal fluid. An epidural catheter is often used for labor and delivery, and sometimes before an operation, such as cesarean section or major abdominal surgery.
The epidural catheter can be left in place for several days if needed to control postoperative pain. A continuous infusion of pain relievers, including numbing medications (local anesthetics) or opioid medications, can be delivered through the catheter to control pain.
Patient-controlled epidural analgesia (PCEA), similar to PCA, enables you to give yourself an extra dose of the pain medication by pushing a button. It, too, has built-in safeguards so that you don't give yourself too much medication.
Some surgeries can be done with spinal anesthesia. Unlike epidural analgesia, this form of pain relief involves medications injected directly into the spinal fluid.
Spinal anesthesia is easier and faster than epidural analgesia is, but it doesn't last as long because there's no catheter to allow the administration of additional medication. Your doctor can add a long-acting opioid to the spinal medication that can relieve post-surgical pain for up to 24 hours.
A nerve block provides targeted pain relief to an area of your body, such as an arm or leg. It prevents pain messages from traveling up the nerve pathway to your brain. Nerve blocks can be used for outpatient procedures or more-involved inpatient surgery.
If you need only several hours of pain relief, your doctor may inject local anesthetics, such as ropivacaine (Naropin) or bupivacaine (Marcaine), directly into a wound or surgical cut, using a very small needle.
For longer pain relief, your anesthesiologist may place a catheter into that area to deliver a continuous infusion of pain medications. Sometimes you may even go home with a nerve block catheter attached to a pump that provides ongoing pain relief.
Combination pain medications
Often called multimodal pain relief, this involves receiving a combination of opioid and one or more other drugs, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), celecoxib (Celebrex), ketamine (Ketalar) or gabapentin (Gralise, Neurontin). All of these medications share the ability to relieve pain, and each can be given in low enough doses to avoid side effects.
The additional drugs are usually given by mouth in tablet form. The combination may improve pain relief and reduce side effects by reducing the need for opioids.
Your doctor also may recommend other methods of pain management, such as rest, ice and elevation, or splinting, depending on the type of surgery. For minor surgery, these tactics are all you need to control your pain. After major surgery, they're usually the last step on the road to healing.
You'll probably be switched to oral medications in the hospital and continue taking them during your first few days — or weeks — at home. Examples include:
- Opioid analgesics. The same or similar medications that are used in an IV catheter or PCA are available in oral form (pills). Oral opioids work well on severe pain, but the relief can come with side effects, including drowsiness, nausea and constipation. Many oral opioids are combined with acetaminophen (Tylenol, others), so be careful not to take too much acetaminophen, which is in many over-the-counter pain relievers, cold medicines and sleep aids.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Traditional NSAIDs — such as ibuprofen (Advil, Motrin IB, others) — reduce swelling, soreness and minor pain. They may be used after minor procedures or combined with opioids for treatment after major surgery or during home recovery. Combining NSAIDs with opioids gives maximum pain relief, but with fewer side effects.
After surgery, you'll need to communicate with your doctors and nurses. Controlling your pain is important to them, too.
- Be honest about the pain you feel after surgery. Let your doctors and nurses know how much it hurts, where it hurts, and what activities or positions make it better or worse. Your health care team will want to know the intensity of pain on a 0 to 10 scale where 0 is no pain, and 10 is the worst pain you can imagine. The more specific you can be, the better your doctors can help you.
- Don't ignore side effects. Tell your care team if you experience sleepiness, constipation, nausea, itching or other side effects of the medications. A different pain medication or dose can sometimes reduce uncomfortable side effects.
Remember: When your pain is under control, you can focus on the important work of healing. So this isn't the time to test your pain tolerance, or grin and bear it. Work with your health care team to make your recovery as prompt and pain-free as possible.
April 18, 2014
- Guidelines on pain management: Post-operative pain management. National Guideline Clearinghouse. http://www.guideline.gov/content.aspx?id=23897. Accessed Dec. 16, 2013.
- Winn HR. Youmans Neurological Surgery. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.clinicalkey.com. Accessed Dec. 16, 2013.
- McMahon SB, et al. Wall and Melzack's Textbook of Pain. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed Dec. 16, 2013.
- Kodali BS. Management of postoperative pain. http://www.uptodate.com/home. Accessed Dec. 16, 2013.
- Wu CL, et al. Treatment of acute postoperative pain. The Lancet. 2011;377:2215.
- Martin DP (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 30, 2013.