After surgery: Medications and methods for pain relief

Your upcoming surgery is unavoidable, but the pain you experience afterward is not. Medications such as opioid analgesics, combined with certain delivery methods, such as patient-controlled analgesia, can reduce or eliminate your postsurgical pain.

Finding the most effective treatment for you — one that balances pain control with the least side effects — can speed your healing and recovery. Understand your options for pain relief so that you can better work with your medical team.

Postoperative pain medications

Nonsteroidal anti-inflammatory drugs and opioid analgesics are two common types of postsurgical pain medications. Depending on the type and extent of your surgery and the amount of pain you experience, your doctor may use one or both of these for pain reduction.

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, reduce swelling and inflammation and relieve pain and fever. These oral medications work by inhibiting an enzyme called cyclooxygenase (COX). This enzyme is responsible for your body's production of prostaglandins, hormone-like substances involved in inflammation and pain. Doctors usually prescribe NSAIDs for mild to moderate pain relief after less-involved procedures, such as dental procedures or removal of small skin lesions, or for home recovery. Side effects of NSAIDs include dizziness, fatigue, headaches, and bleeding or ulcers in the digestive tract.
• Opioid analgesics (narcotics), such as morphine, relieve pain by decreasing transmission of pain messages to the brain. Some opioids are natural compounds derived from opium, others are synthetic medications that work in a similar way. These medications — usually given orally or injected into a vein — are used for moderate to severe postoperative pain. A doctor prescribes this type of medication after more-involved procedures, such as abdominal or back surgery. Common side effects include sleepiness, nausea, vomiting, itching and constipation. Doctors often prescribe NSAIDs and acetaminophen along with opioid medications. This maximizes pain relief with lower doses of opioids, causing fewer side effects.

Delivery of pain medications

If you undergo a minor procedure, your doctor may prescribe an oral pain medication, likely in a pill, tablet or liquid form. But if you undergo a more extensive surgery, such as abdominal or chest surgery, your doctor has other ways to deliver the pain medication.

Patient-controlled analgesia (PCA)
Before your surgery, a needle is used to insert a slender plastic tube into a vein in your hand or arm (intravenous, or IV) to give you fluids, anesthetics, antibiotics or pain medications. After your surgery, your doctor may keep the IV line in place to deliver pain medications.

Many hospitals offer patient-controlled analgesia — a system that allows you to control the amount of pain medication you receive. The system delivers a dose of pain medication to your bloodstream through a vein when you press a button. The dispenser is programmed so that you can't give yourself too much medicine. In fact, the machine ignores your request if you push the button too frequently. This way each dose of pain medicine has sufficient time to work before you receive another dose.

Patient-controlled analgesia may decrease anxiety because you aren't dependent on others to receive your pain medicine. This method also reduces side effects by allowing lower doses of medicine to be given more often, thereby minimizing high concentrations of medicine in your bloodstream.

Patient-controlled analgesia (PCA)

Patient-controlled analgesia (PCA)

The patient pushes a button, and a machine delivers a dose of pain medicine into the bloodstream through a vein.

Close

Placement of the epidural

Placement of the epidural

During the placement of the epidural, you lie on your side and curl up into a ball, or you may sit on the edge of the bed and lean forward. An anesthetic is used to numb the area, and then the epidural needle is inserted between two vertebrae and into tissue near the spinal column. A thin, flexible tube (catheter) is threaded through the needle, and the needle is removed. A continuous infusion of medicine is injected into the catheter.

Close

Talk to your doctor about your pain relief options

If you're concerned about your surgery and the possible pain afterwards, talk to your doctor. An open discussion can put your mind at ease and help your doctor create the best postsurgical plan for you. Knowing your options, asking questions and communicating openly with your medical team can help limit your pain and speed your recovery.

Before surgery
Talk to your doctor about your previous experiences with different kinds of pain control. Discuss what has worked for you and what hasn't. Also, be ready to name all prescribed and over-the-counter medications and any supplements or herbs that you're taking and have taken in the past month and in what doses. Other medications, herbs or supplements can interact with pain medications, so it's best to tell your doctor upfront if you take any.

It's particularly important to tell your doctor if you experience other pain problems that may add to the anticipated surgical pain. If you take pain medications on a regular basis, your body may be tolerant to their effects, and you may require higher than usual doses to achieve adequate pain control.

Also, be sure to tell your doctor if you have had problems with substance abuse in the past, including alcohol, prescription drugs or illegal drugs. If so, you and your doctor can make a plan for pain control that minimizes the risks of relapse.

Discuss your concerns about the surgery and the pain it may cause before your surgery. Questions to ask include:

• How severe is the pain after this type of surgery, and how long does it typically last?
• Will pain medications be given both before and after surgery? If so, what kind and for how long?
• Can the surgery be done with regional anesthesia?
• How will the pain medication be given and at what intervals?
• What are the possible side effects of the medications? What steps will be taken to minimize these side effects?

After surgery
After surgery, tell your doctors and nurses if you feel pain. Let them know what hurts, how much it hurts and where it hurts. Your medical team may ask you to rank your pain on a scale from 0 to 10. Zero is no pain, and 10 is the worst you can imagine. What you tell them helps manage your pain.

Also, tell your doctors and nurses if you experience any side effects from the medications, such as constipation or nausea. The doctors can prescribe a different pain medication, lessen the dose or prescribe another drug to help limit these side effects.

By learning about your options, asking questions and discussing your concerns, you can actively participate in your pain management decisions. Working together, you and your medical team can make your postoperative recuperation as pain-free as possible.