Managing Pain After Surgery

Dealing with post-surgery pain begins before your operation.

From the WebMD Archives

Hearing your doctor utter the words, "We’re going to have to operate," can send a shiver down your spine. Immediately, questions about the seriousness of your condition, the procedure itself, and the likelihood that it will cure what ails you flood the mind. Then, there is the prospect of post-surgery pain. How badly is this going to hurt?

The bad news is that some pain is an inevitable companion to most types of surgery. The good news is that there are many highly effective medications to keep post-surgical pain under control. In addition to the benefit of greater comfort, experts say well-controlled pain can speed recovery and prevent long-term problems.

In order to make sure you’re getting the best possible treatment for your post-surgical pain, experts advise taking an active role and keeping the channels of communication open between you and your doctor -- starting before your operation.

Start Before Surgery

The time to talk with your surgeon and anesthesiologist about how your pain will be managed after surgery is during pre-surgery testing, not after the procedure has occurred, says Michel Dubois, MD, director of research and education and professor of clinical anesthesiology at the NYU School of Medicine.

Here are some important items to discuss with your doctor before making your way to the hospital:

Tell them about everything you're taking. Your doctor needs to know about all supplements, prescription drugs, and over-the-counter medications you take, in order to prevent dangerous drug interactions.

Ask how much pain to expect and how long will it last. Everyone handles pain differently. Still, each type of surgery generally involves a certain level and type of pain.

For instance, Eduardo M. Fraifeld, MD, president of the American Academy of Pain Medicine, says that following back surgery people commonly experience a lot of muscle spasms. Abdominal surgery, on the other hand, typically causes cramping pain as the bowels work to get back to normal.

It’s useful to know ahead of time what is typical for the kind of surgery you’re undergoing and how long you can expect it to last. Being prepared for what’s to come may help you feel less anxious, particularly if the pain you experience is in line with what you were told to expect. And if your pain is significantly more intense or longer lasting than what you and your doctor discussed, you’ll know to bring it to his or her attention.

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Learn about possible side effects of pain medication and what you can do about them. One of the problems with opioids, a commonly used class of post-surgery pain medications, is that they have side effects, Fraifeld says. "Not just drowsiness and sedation, but you’ve got nausea, urinary retention, and constipation, which cause a lot of other significant effects and prolongs the healing."

Many people, he says, haven’t discussed possible medication side effects with their physician and are caught off guard. Often, side effects will cause people to stop taking their medication. This may be a mistake.

"Just because you had a side effect with one medication doesn’t mean we can’t try another that has fewer side effects," Fraifeld says.

Nausea, in particular, presents a problem for many people taking pain medication. Fraifeld advises people who often get nausea to inform their surgeons ahead of time that that is a likely problem for them.

"There are medications we can put people on ahead of time to reduce [nausea]… or we can change the anesthetic technique entirely," Fraifeld says.

Develop a plan for when you go home. Ask your doctor about what can be done to ensure that your pain will be properly addressed once you leave the hospital. This is particularly important to your long-term recovery.

"Unfortunately, there are still a lot of doctors who don’t adequately treat post-operative pain," Fraifeld says. "People get pain medication that lasts three, four, or six hours at most, and are told to take it twice a day. That’s clearly inadequate."

After your surgery, it’s important that you communicate openly with your doctors and nurses about what you’re feeling while you recover.

Talk about your pain. Now is not the time to tough it out. If you have pain -- whether it's at the site of the incision or elsewhere in your body -- tell your doctors and nurses. They will be better able to keep you comfortable if you are very descriptive about where and how much it hurts.

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Stay ahead of your pain. A common mistake people make, according to Fraifeld, is waiting too long to take pain medication. By the time you’re in pain, you’re starting from behind the eight ball. "It takes a lot more medicine to control pain after it’s started as opposed to starting it ahead of time," he says.

Stick to the medication schedule set by the doctor. That will keep medication flowing through your system and your level of pain at a more even and manageable level.

Conditions that Complicate Pain Management

Pre-existing medical conditions can complicate pain management after surgery. According to Fraifeld, there are a few conditions that commonly interfere with post-surgical pain management.

Chronic pain

If you have a chronic pain condition, your body may be under additional stress because following surgery you’ll likely feel the pain you’ve been experiencing, as well as pain associated with the surgery.

In addition, people with chronic pain conditions often take medication to manage it. Long-term use of pain medication can lead to medication tolerance, meaning the drugs don’t work as well as they once did to block pain and that greater dosages are needed to get the same effect. This makes post-surgery discomfort much more difficult to manage. With prior knowledge of your condition, Fraifeld says, your doctor has the opportunity to coordinate with other care providers managing your chronic pain and to choose medications that will help to keep you comfortable.

Addictions

Often, for fear of being stigmatized, people with addiction issues will keep very quiet about it, leaving their doctor in the dark.

It is common for people recovering from addiction to refuse opioid treatment, Fraifeld says. Those being treated for addiction with methadone can also face more difficulty controlling their pain after surgery. Without prior knowledge, Fraifeld says, doctors often scratch their heads in confusion wondering why their efforts to manage someone’s pain are not working.

Tell your surgeon about addiction issues ahead of time, so that they can work with the maintenance program treating your addiction to manage your pain while controlling the level of narcotics you’re being given.

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Most people with addictions don't end up in relapse because of pain medication use following a surgery, "but it takes a lot of communication and coordination," Fraifeld says.

Sleep Apnea

Sleep apnea – in which people briefly stop breathing while they sleep – is a condition that's particularly important to discuss with your surgeon. Common pain medications can affect breathing patterns, which puts people with sleep apnea at a higher risk for complications, Fraifeld notes. He recommends that people with sleep apnea bring their continuous positive airway pressure (CPAP) machine to the hospital to assist their breathing while they sleep.

Manage Post-Surgical Anxiety and Depression

Anxiety and depression can make pain worse and much more difficult to manage. Understandably, both are very common in people having surgery.

But there is hope. There are various therapies available to treat the symptoms of anxiety and depression.

Social issues can also emotional issues. For example, an elderly person who is having surgery to fix a broken a hip may realize that the incident will require him or her to change living conditions. A parent who has four children at home to care for will understandably feel anxious about their kids' well-being while they are away undergoing surgery. These issues should be openly discussed with your doctors and nurses as well.

"Sometimes you have to bring in social workers, family, and other members of the community," Fraifeld says. "It’s difficult for physicians to be responsible for all the social issues, but you at least have to be cognizant of them and to just look into alternative ways to work around these other problems."

Managing anxiety and depression after surgery, whether with medication or social support often reduces the need for pain medication, Fraifeld says, and is extremely important for long-term recovery.

WebMD Feature Reviewed by Laura J. Martin, MD on March 12, 2010

Sources

SOURCES:

Michel Dubois, MD, director of research and education and professor of clinical anesthesiology, NYU School of Medicine.

Eduardo M. Fraifeld, MD, president, American Academy of Pain Medicine.

Mayo Clinic: "Pain Medications After Surgery."

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