Managing Surgical Pain - Your Role is Important

Severe pain after surgery is no longer necessary. Patients can work with the nurses and doctors before and after surgery to prevent or relieve pain and discomfort.

Pain control after surgery can help you:

• enjoy greater comfort while you heal;
• start walking, do your breathing exercises and regain your strength more quickly so you get well faster;
• avoid complications, such as pneumonia and blood clots.

Analgesics and Anti-Inflammatory Drugs
Acetaminophen, aspirin, ibuprofen and other medications can reduce swelling and soreness and relieve mild to moderate pain. These medicines may be combined with others for improved pain control.

Local Anesthetics
Similar to Novocain, these medications are used during certain types of surgery to block the nerves that transmit pain signals. They are given either near the incision or through a small tube in the patient's back. Local anesthetics seldom cause drowsiness or constipation and they may reduce the need for opioid use.

Opioids
Morphine, codeine and other opioids are most often used for acute discomfort such as short-term pain after surgery. These medications may cause drowsiness, nausea or constipation. Short-term use for acute pain relief rarely results in addiction.

Pain Education
Learning about the operation and what to expect helps reduce anxiety.

Relaxation
Simple exercises suggested by your caregiver can increase comfort.

Music
Music can provide relaxation and distraction.

Physical Agents
Heat or cold therapy, massage, healing touch, rest and good body alignment can lessen pain.

Tablets or Liquid
Medicines taken by mouth cause less discomfort than injections and can work just as well.

Injections into the Skin
Medicine given by injection into skin or muscle is effective even if you are nauseated or vomiting.

Injections into the Vein
Medicine is injected into the vein through a small tube called an intravenous (IV) catheter. Medicines given this way act quickly. Patient Controlled Analgesia, or PCA, allows you to control your own IV pain medicine by the push of a button within pre-set limits established by a physician. Your caregiver can give you more details.

Nerve Block (Epidural Analgesia)
Medicine is injected in the back through a small tube called an epidural catheter. This works well when you have had chest surgery or surgery on the lower part of your body. Some patients remain pain-free for hours.

Being prepared helps put you in control. Ask the doctor or nurse what to expect. You might like to know:

• Will I have much pain after surgery?
• Where will it occur and for how long?

Discuss pain control options with your doctor and nurse.

• Talk about pain control methods that have worked well (or not so well) for you in the past.
• Tell them about concerns you may have about taking pain medicine.
• Report any drug allergies you have.
• Ask about side effects associated with different treatments.

Ask about the schedule for pain medicine in the hospital.

• Some people get pain medicines only upon request.
• Taking pain medication at set times instead of waiting until the pain breaks through often has better results.
• Patient Controlled Analgesia allows you to control the delivery of your pain medicine.
• Your doctor and nurse will work with you to design the best pain management plan for your needs.

Take (or ask for) pain relief medication when the pain first begins.

• Take action as soon as the pain starts.
• If you know your pain will worsen when you start walking or doing exercises, take the pain medicine first. Pain is harder to manage once it has taken hold. This is a key step in proper pain control.

Help doctors and nurses "measure" your pain.

• You will be asked to rate your pain on a scale of 0 to 10. (See Patient Education/Pain Management.) [Link to: http://www.greenhosp.org/greenwich/ps_education.htm] Zero is equal to "no pain" and 10 is equal to "the worst possible pain." A visual scale is available for children. Reporting your pain in this way helps the doctors and nurses know how well your treatment is working and whether to make any changes.
• You will also set a pain control goal, such as "having no pain that is worse than 2 on the scale."

Tell the doctor or nurse about any pain that will not go away.

• Pain can be a sign of problems with your surgery.
• Do not worry about being a "bother." The nurses and doctors want and need to know if you are feeling pain.

The Mayday Pain Project
http://www.painandhealth.org

Worldwide Congress on Pain
http://www.pain.com