Know Your Options for Managing Pain after Surgery

If you find yourself heading to the operating room, you're not alone. Each year, 51.4 million people undergo in patient surgical procedures in the United States for various reasons. While preparing for the surgery itself is important, preparing for what happens after the surgery is crucial to ensuring a smooth and comfortable recovery.
Working with your health care provider to develop a plan to manage postsurgical pain is an important first step.


The importance of pain management
Pain control not only makes you more comfortable, it can help you recover faster and may reduce your risk of developing certain complications after surgery, such as pneumonia and blood clots. If your pain is well controlled, you will be better able to complete important tasks such as walking and deep breathing exercises.

Customizing your pain management plan
Your initial pain management plan will be decided before you go into surgery based on a review of your medical and surgical history, results from laboratory tests and a physical exam.

A combination of medications may be used to block the pain in different areas.  There are new options for pain management that you may not be familiar with, and your health care professional can advise you about which medications may be best suited to safely minimize your discomfort.

Ultimately, you are the one who decides which pain control options you'll use. After surgery, you will be assessed frequently to ensure that you are comfortable and safe. When necessary, adjustments or changes to your pain management regimen will be made.

Pain management options
Many surgeons and hospitals now use a "multimodal approach" to pain management to reduce the total exposure to any one product, especially narcotics. This means that you may receive more than one type of pain treatment, depending on your needs and the type of surgery you are having, to control pain in different ways. Pain medications may be given before, during or after surgery. All pain medications are relatively safe, but, like any therapy, they are not completely free of risk. Before your surgery, discuss what options are best for you.


Pain management options include:

• Acetaminophen: Acetaminophen (such as Tylenol) is generally used alone for mild to moderate pain and can be prescribed in addition to stronger pain killers for severe pain. Although side effects are generally mild, acetaminophen can cause liver damage when used in excess. Acetaminophen is often combined in a pill with a narcotic. If you are prescribed a medication that contains acetaminophen, speak to your health care provider before taking any additional over-the-counter products containing acetaminophen.

• Aspirin: Aspirin is commonly used to relieve mild to moderate pain and can also be used to prevent blood clots. Aspirin can sometimes cause stomach upset and, in rare instances, may cause internal bleeding, which is why it is not usually prescribed after surgery.

• NSAIDs: Nonsteroidal anti-inflammatory drugs, or NSAIDs, include medications such as ibuprofen (i.e., Motrin, Midol and Advil) and naproxen (i.e., Aleve and Naprosyn). NSAIDs help with swelling and inflammation but have been associated with bleeding and kidney or stomach problems in some patients. Because a lot of inflammation occurs after surgery, these medications are often prescribed.

• Local anesthetics: Local anesthetics are another option to control pain. These are numbing medications that can be placed by your surgeon or anesthesiologist into the site of surgery, around the nerve that provides sensation to the surgical site (a so-called "nerve block"), or close to the spinal cord by a procedure called an epidural. One commonly recognized type of local anesthetic is Novocaine, often used by dentists to numb the mouth during dental procedures.  Most local anesthetics last for up to 8 hours when administered into the surgical site.

If your surgeon wants to prolong the effect, he or she may administer a long-lasting version that slowly releases the numbing medication over time to last as long as the most severe postsurgical discomfort.

• Narcotic medications: After surgery, it's common to receive a narcotic medication (such as oxycodone, hydrocodone or morphine), which dulls the body's overall response to pain. Your health care professional may also refer to these drugs as opioids. You may receive a narcotic in the hospital after your surgery. Before leaving the hospital, you may also receive a prescription for additional narcotics to help manage your recovery.
  
  Narcotics are powerful pain relievers and can be important to manage some types of postsurgical pain. However, narcotics are commonly associated with nausea, vomiting and sedation. Some patients may also develop tolerance to narcotics over time, which means they need higher doses to get the same level of relief. If you are concerned about addiction, or have a history of substance abuse (alcohol or any drug), talk with your health care professionals. They will monitor you closely during your recovery. If issues arise following surgery, they will consult the appropriate specialists.

Types of postsurgical pain
Your postsurgical discomfort may not be limited to the incision itself. You may or may not feel the following:

• Muscle pain in the neck, shoulders, back or chest from lying on the operating table
• Shoulder pain resulting from the air injected into the abdomen during minimally invasive surgery
• Sore or scratchy throat (if a breathing tube was used)
• Pain when sitting up, walking and coughing

How to measure your pain
After your surgery, health care professionals likely will ask you to "measure" your pain on a scale of 0 to 10, with "0" being "no pain" and "10" being "the worst pain you can imagine." Reporting your pain as a number helps them understand how well your treatment is working and decide whether to make any changes in your pain management. In addition to the 0 to 10 scale, you might be asked to rate your pain based on words, such as mild, moderate or severe, or using diagrams such as a frowning face or happy face. Remember that it’s important to be specific about the type of pain you are feeling (is it at the surgical site? Is it in your shoulder? Is it a headache?), this will help your surgeon better assess the situation.

If at any time you feel uncomfortable—for example, having difficulty breathing or coughing—it is crucial that you tell your attending health care professional, so adjustments can be made.

Managing pain at home
It's important to stay ahead of your pain and not let it get out of control. If you wait too long to take your medication, you may need more to control the pain. In most cases, you will be given a prescription for pain medication before or after surgery. You may be able to fill the prescription at the hospital pharmacy or it may be sent in to your local pharmacy for pickup on your way home.

Be sure to follow the instructions that come with the prescription. The directions should tell you when and how often to take the drugs, whether you should take with food and how much you can take in a day. If you have any questions, ask your pharmacist or health care professional. Your health care professional may advise you to take your pain medication at regular intervals (such as every 4 to 6 hours).

Make sure to get enough rest, and if you're having trouble sleeping, talk to your health care professional.

Recovery time
Recovery time varies based on the surgical procedure. Managing your postsurgical pain in an effective and safe way may speed your recovery and have you on your feet in no time.