Pain Management
Pain control after surgery

Pain is your body's way of telling you something is wrong. It is normal to expect a certain amount of pain following surgery; however, if pain does not subside with pain medication, there may be a more serious problem. Your physicians and nurses will ask about your pain because they want you to be comfortable. It is important that they be alerted if their efforts to control your pain are not effective.

With today's new and improved pain medications, there is no reason for anyone to tolerate severe pain. By effectively treating pain, you will heal faster, have fewer complications following surgery, and be able to go home and resume normal activities sooner.

The importance of discussing pain control before your surgery:

Discuss pain control options with your physician before you have surgery. Talk about pain control methods that have worked well, or not worked well for you in the past. Also, discuss the following with your physician:

• Concerns you have about medications
• Medications that have not worked well for you
• Allergies you have to any medications or drugs
• Side effects of pain medications that might occur
• Prescription and over-the-counter medications you take for other conditions

Pain medications are given in one of the following ways:

• Upon request
  You can ask the nurse for pain medicine as you need it. 
  
  
• Pain pills or shots given at set times
  Instead of waiting until you experience pain, you are given pain medicine at certain, regular times throughout the day to keep the pain under control.
  
  
• Patient controlled analgesia (called PCA)
  You control the administration of the pain medicine by pressing a button to inject medicine through an intravenous tube in the vein.
  
  
• Patient controlled epidural analgesia (called PCEA)
  This type of administration provides continuous pain relief. A tube is inserted in the spine, and when you press a button, the pain medicine goes into an epidural tube, which is inserted in the back.

Your physicians and nurses will want to know how your pain medicine is working and whether or not you are still experiencing pain. The physician will change the medicine, and/or dosage, if necessary.

What are the different types of pain relief medications commonly used after surgery?

The amount of post-operative discomfort depends on various factors, particularly the type of surgical procedure you have undergone and your threshold for pain. Discuss your pain management options with your physician, including the various types of pain medications and their side effects.

Some of the pain relief medications following surgery may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
  Some examples of this type of medication are aspirin and ibuprofen (i.e., Advil and Motrin). These medications are most often used for mild or moderate pain. NSAIDs carry no risk of addiction, and depending on the amount of pain, they may eliminate the need for stronger medications. NSAIDs, however, may interfere with blood clotting and may cause nausea, vomiting, or kidney problems.

• Opioids
  Opioids include drugs such as morphine and codeine, which are most often used for acute pain, and may be given immediately following surgery. Contrary to popular belief, it is rare for a patient to become addicted to opioids following surgery. Opioids may cause dizziness, nausea, vomiting, constipation, or itching and other skin rashes.

• Local anesthetics
  More than 100 drugs are available for local anesthesia. These drugs act by blocking the transmission of nerve impulses and are often administered for severe pain in a limited area of the body, such as the incision site. Several injections may be necessary to control the pain, and too much anesthetic can have various side effects.  
  
  
• Acetaminophen
  Acetaminophen (i.e., Tylenol) is one type of pain reliever that is unlikely to cause the stomach irritation that may be associated with aspirin, naproxen sodium, ketoprofen, and even ibuprofen, the active ingredients found in some other nonprescription pain relievers. Certain acetaminophen products may also be less likely to interact with other medications you may be taking. Use of all types of pain relievers is not recommended, unless directed by your physician.

Breathing and relaxation exercises can also help in controlling pain. Consult your physician for more information.

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I've often thought that it'd be nice if the pain "contract" were bilateral for occasions such as the one you are asking about.

Chronic pain patients have almost no chance of getting what they need after surgery because the people in the hospital "disapprove" of what pain patients are already getting, going in. As you might note re the doctor who wrote recently to the list wondering about giving Naltrexone during anesthesia, the patient's safety is not the first thing on the minds of many people working in medicine. Shocking but true.

At the very least, I'd contact the patient advocate before going in and bring the JCAHO number with you, displayed prominently so the docs and nurses can see you have it. Don't be afraid to use it.

If you want to be even more aggressive, and risk drawing the wrath of the hospital staff, write a letter to all concerned, way before the surgery, being specific about just what kinds of doses may be required, stating that you expect to be given what you need and that your pain will be treated in accordance with JCAHO principles. Ask them to write you back giving you written assurance that they will comply. If they refuse, ask for that in writing and send it to JCAHO.

Contact JCAHO by either calling:
1-800-994-6610 Fax: 1-630-792-5636
Or Write To:
[email protected]

If you file a complaint with JCAHO, one of the following actions will be taken:

Incorporate in monitoring database.
Review complaint at next survey.
Ask organization to provide written response.
Conduct unannounced on-site evaluation.

Go as high up as you need to and get written assurances before you agree to surgery...because once they've got you, they've got you.

Good luck,
Siobhan Reynolds