Pain Relief After Surgery
Everyone responds differently to pain after surgery. Doctors measure pain using a standard scale of zero (no pain) to 10 (the worst pain imaginable). But even using the pain scale, people's tolerance levels can vary greatly.
“A patient who rates pain as a 10 out of 10 may say, ‘I’m fine.’ Another patient who is a two out of 10 may be screaming,” says Donna-Ann Thomas, MD, division chief of Regional Anesthesiology & Pain Medicine for Yale Medicine.
At Yale Medicine, our doctors take pain seriously and consider it a medical problem that requires attention. Most pain can be eased or greatly relieved with proper management. Our experts use the latest medications, techniques and approaches to keep patients who have had surgery comfortable throughout the recovery process.
How much pain should a patient expect to feel after surgery?
Most patients have some pain after surgery, especially within the first 48 hours, and it's normal to have pain for several weeks. “Zero pain is not realistic, so that isn’t the goal,” says Dr. Thomas.
However, she says, people should be able to function somewhat normally. "You ought to be able to go about your day without having to fixate on the pain,” Dr. Thomas says. "The pain should be tolerable. You should be able to sleep, eat, dress, and shower while you heal from your surgery."
How is acute pain managed after surgery?
Immediately after surgery, pain medications may be given through a catheter already in place. For example, two ways of controlling postoperative pain are opioid (narcotic) medication given through an intravenous catheter (or I.V.) and a local anesthetic given through an epidural catheter in the lower back.
If the surgeon requests it, an anesthesiologist can place a nerve catheter or simply give an injection of local anesthetic to block pain signals to nerves near the incision. But, in order to go home from the hospital, patients who have had this injection must be transitioned to taking oral pain medications.
“We try to change from I.V. meds to pain meds taken by mouth when the patient starts eating,” Dr. Thomas says. Pain pills can take a while to build up in a person’s body, but their pain-relieving effects last longer than I.V. medications. Intravenous medications act quickly but do not last as long in the body. “Most patients do better with the oral medications,” Dr. Thomas says.
Who manages pain after surgery?
The anesthesiologist is responsible for managing each patient’s pain throughout surgery as well as in the recovery room. Afterward, the surgeon takes responsibility for the postoperative pain. A surgeon may seek the help of a pain physician or a regional anesthesiologist, who is an expert in using local anesthetics to block pain sensations in a particular area of the body. These specialists can offer options such as a regional block that numbs the area.
If a patient would benefit from a regional block, it's likely that he or she would be assigned to have one placed before surgery. “We work with our surgeons to decrease pain and side effects to get you home after surgery,” Dr. Thomas says.
What types of medications are used for pain after surgery?
Over-the-counter medications, such as acetaminophen and ibuprofen, work very well for minor surgeries and laparoscopic ones. For bigger procedures—such as joint replacements, spine surgery or cardiac surgeries—opioid medications might be needed. Patients who need surgery for broken bones may also need opioids.
“Opioid medications help with surgical pain,” Dr. Thomas says. “However they have the potential to cause side effects, like slowing your breathing, nausea, vomiting and constipation.”
Of great concern, also, is that opioids pose a risk of addiction and misuse if pain pills are used for reasons other than pain after surgery. “Our goal is to reduce the use of opioid medications by using other types of medications and regional anesthesiology. It helps to decrease the risks and side effects that come with opioid pain medications," Dr. Thomas says.
How can you ensure that your pain after surgery will be managed appropriately?
People respond differently to both pain and pain medications for a variety of reasons. Sometimes response to pain is related to genetics or lifestyle factors. What works well for one person might not for another. For example, oxycodone, which is a narcotic, may prove unhelpful to a patient for whom morphine, another narcotic, works well.
This happens with basic nonsteroidal anti-inflammatory drugs (NSAIDs), too. For instance, some people experience pain relief from celecoxib, a NSAID but others won’t. “If I’m increasing the medication and the patient isn’t getting much benefit from it, I’ll switch to another,” Dr. Thomas says.
Before or after surgery, your doctors may ask about pain medications that have worked for you in the past. Those are often good options to try again. Your doctors will also observe how your body responds to pain medications during the surgery.
How is Yale Medicine’s approach to acute postoperative pain unique?
Since Yale Medicine is an academic institution training the doctors of tomorrow, our physicians develop, apply and teach the latest techniques in medicine.
Yale Medicine physicians offer many regional approaches to pain management and have a lot of experience delivering them. “We’re finding more and more that it is important to offer regional anesthesiology to patients,” Dr. Thomas says.
Yale Medicine is often able to offer a wider variety of medicines, equipment and techniques than are easily available in other places. For instance, says Dr. Thomas, procedures such as paravertebral blocks (of the spinal nerve) and tap blocks (of peripheral nerves) may not be offered at community hospitals.
The pain doctors at Yale Medicine take a multimodal approach when treating postoperative pain. “We have an appreciation for a lot more than just opioids,” Dr. Thomas says. “And we address different types of pain that may be overlooked. That’s where our expertise comes in.”