Pain Control: What You Need to Know
Pain is a worry for most people. But it is comforting to know that
pain control is an important part of your recovery. Every effort is made to
minimize your pain; however, it is normal to experience some discomfort after
surgery.
We provide the following information to help you understand your pain
treatment, to describe how you can help your doctors and nurses control your
pain, and to empower you to take an active role in making choices about pain
treatment.
Be sure to tell your doctor about all medications
(prescribed and over-the-counter), vitamins and herbal supplements your are
taking. This may affect which drugs are prescribed for your pain control.
Why is pain control so important?
In addition to keeping you comfortable, pain control can help you recover
faster and may reduce your risk of developing complications after surgery. If
your pain is well controlled, you are likely to start walking and to begin your
breathing exercises sooner. These activities will help you get your strength
back and avoid problems, such as pneumonia and blood clots, that can occur after
surgery.
What kind of pain will I feel after surgery?
You may be surprised at where you experience pain after surgery. Often times
the incision itself is not the area of greatest discomfort. You may or may not
feel the following:
Muscle pain
You may feel muscle pain in the back, shoulders or chest from lying on the
operating table.
Throat pain
Your throat may feel sore or scratchy if a breathing tube was placed in your
throat during surgery.
Movement pain
You may feel pain at the incision site when you begin to move about. When
you start sitting up, coughing and walking, you may feel some muscle aches and
pain.
What can I do to help keep my pain under control?
Most importantly, you can help the doctors and nurses "measure"
your pain. While you are recovering, your doctors and nurses will ask you to
rate your pain on a scale of 0 to 10 with "0" being "no
pain" and "10" being "the worst pain you can imagine."
Reporting your pain as a number helps the doctors and nurses know how well your
treatment is working and whether to make any changes. Keep in mind that your
comfort level (ie, ability to take deep breath or cough) is more important than
absolute numbers (ie, pain score). And don't worry about being a
"bother." Your doctors and nurses want and need to know about any pain
that is not under control.
Who is going to help manage my pain?
Working with you, your surgeon will decide what type of pain control would
be most beneficial for you after surgery. Your surgeon may also choose to
consult the Acute Pain Management Service to help manage your pain
following surgery. Anesthesiologists on this service are trained in the types of
pain control treatment options described below.
The manager of your post-surgical pain -- your surgeon or the Acute Pain
Management Service team -- will review your medical history, check the results
from your laboratory tests and physical exam, and consider the type of surgery
you are having or have had to determine the pain management option best suited
to minimize your discomfort. After surgery, you will be assessed daily to make
sure that you are comfortable, adjust your therapy if needed, and monitor you
for any side effects.
Types of Pain-Control Treatments
You may receive one or more types of pain-control treatments, depending
on your needs and the type of surgery you are having. All of these treatments
are safe; however, side effects of itching, nausea, and drowsiness can occur.
These side effects are common with narcotic pain medicines regardless of how the
medicines are given.
Don't worry about getting "hooked" on pain medicines. Studies show
that this kind of addiction is very rare after surgery (unless you currently
have or previously had a drug abuse problem). Please discuss any concerns you
may have with your anesthesiologist or surgeon before your surgery.
Patient-Controlled Intravenous Analgesia
Patient-controlled analgesia (PCA) is a computerized pump that injects pain
medicine into an intravenous (IV) catheter (small plastic tube) that has been
inserted into your arm. To request pain medicine, you simply push a button. In
this way, you receive pain relief when you need it.
- You will not be able to give yourself too much pain medicine because the
amount is limited to the dose prescribed by your surgeon or the acute pain
management service.
- PCA provides stable pain relief. Many patients like the sense of control
they have over their pain. Since pain relief is only a button-push away, you
can relax and perhaps recuperate faster.
Do not allow family members or friends to push your PCA
pump button for you. You need to be awake enough to know that you need pain
medication.
Patient-Controlled Epidural Analgesia
Many people are familiar with epidural anesthesia because it is frequently
used to control labor pain during childbirth. Patient-Controlled Epidural
Analgesia uses a PCA pump to deliver pain-control medicine into a catheter
(small plastic tube) that is placed into your back.
Placing the catheter (to which the PCA pump is attached) usually causes no
more discomfort than having an IV started. First, an area of your back will be
cleaned and numbed with a local anesthetic. A sedating medication, given through
your IV, may also be given to help you relax. Next, a needle will be carefully
inserted into the "epidural space," which is the area between the
vertebrae and a sac filled with spinal fluid. A thin catheter will be inserted
through this needle and the needle will then be removed. Following surgery, by
pressing a button on the PCA pump, you will be able to give yourself pain
medicine. When the PCA pump is no longer needed, removal of the epidural
catheter is a painless process.
Patients who receive epidural analgesia typically have less pain when they
take deep breaths, cough, walk, and they may recover more quickly. For patients
with medical problems such as heart or lung disease, epidural analgesia may
reduce the risk of serious complications such as heart attack and pneumonia.
Although side effects from epidural analgesia are uncommon, they can occur.
Most of these are minor and short term, and may include headache, lowered blood
pressure, or numbness and weakness in your legs. All of these side effects can
be treated and managed.
Nerve Blocks
Pain relief in a specific part of your body may be provided through a nerve
block. A nerve block is performed with a long-acting anesthetic, which keeps the
surgical area "numb" for several hours after surgery. This block will
greatly reduce the amount of pain medication needed for you to remain
comfortable. An example of this pain management approach that you may be
familiar with occurs in your dentist's office. Your dentist often uses a nerve
block to numb your mouth before drilling your teeth.
In some cases, a nerve block can also be used for the anesthesia for the
surgery. You will also be given medications during your surgery to keep you
sleepy. This type of anesthesia provides the added benefit of pain relief both
during and after your surgery. Your anesthesiologist and surgeon will decide
before surgery if a nerve block is a suitable pain management option for you.
Pain Medications
Once the PCA pump has been stopped, your doctor will order oral pain
medicine which you will receive as needed for pain. Most oral medications can be
taken every 3 to 4 hours. Be sure to inform your nurse when you are beginning to
feel uncomfortable and ask for your ordered medication. Do not wait until your
pain is severe!
Additional medicine will be ordered in case the scheduled medicines do not
control your pain. The doctors and nurses will ask you how the pain medicine is
working and change the medicine, its dose, or its timing if needed.
What are some of the risks and benefits associated with pain medication?
Be sure to inform your doctor if you are taking pain medication at home on a
regular basis and if you are allergic to or cannot tolerate pain medication.
Narcotics after surgery (Morphine and Fentanyl):
Benefits: These drugs will be used immediately after
surgery. They control severe pain.
Risks: These drugs do cause severe drowsiness, nausea
and often times constipation.
Narcotics at home (Percocet, Darvocet, Tylenol #3)
Benefits: These drugs are very effective at controlling
mild to moderate pain.
Risks: These drugs are still narcotics and will cause
drowsiness. Be very careful at home when using these drugs. Stomach upset is a
common side effect but can be lessened if the drug is taken with food. Do not
take more than is prescribed. If your pain is not controlled after taking the
drug as prescribed, call your doctor.
Analgesics (Tylenol, Feverall)
Benefits: These drugs are very effective at controlling
mild to moderate pain. They are also easily tolerated by most patients and
rarely interact with other medications.
Risks: Although generally safe, these drugs can be
associated with liver problems if you take more than advised by your doctor.
Liver problems caused by analgesics occur more often with patients who are
chronic alcohol drinkers.
Nonsteroidal Anti-inflammatory Drugs (NSAIDS) ibuprofen (Advil), naproxen
sodium (Aleve), rofecoxib (Vioxx), celecoxib (Celebrex)
Benefits: These drugs reduce swelling and inflammation
and will relieve mild to moderate pain associated with this swelling. Ibuprofen
and naproxen sodium are available without a prescription but you should ask your
doctor about the dose before you leave the hospital. Celebrex also
reduces swelling and inflammation but does require a prescription.
Risks: The most common side effects of nonsteroidal
anti-inflammatory medication (NSAIDS) are stomach upset and dizziness. You
should not take these drugs without your doctor's approval if you have kidney
problems, a history of stomach ulcers, heart failure or are on other blood
thinner medications such as Coumadin (warfarin).
Are there ways I can relieve pain without medication?
Yes, there are other ways to relieve pain and it is important to keep an
open mind about these techniques. When used along with medication, these
techniques can dramatically reduce pain.
Relaxation tapes or Guided Imagery is a proven form of focused relaxation
that coaches you in creating calm, peaceful images in your mind, a "mental
escape." For the best results, practice using the tape or CD before your
surgery and then use it twice daily during your recovery. The Cleveland Clinic
has had great success with this relaxation program. You can get relaxation tapes
at the bookstores, or rent them at the library. Guided Imagery tapes are also
available at the Cleveland Clinic Gift Shop. Finally, you can bring a battery
operated tape recorder or CD player to the hospital to play prior to surgery and
during your hospital stay.
At home, heat or cold therapy may be an option that your surgeon may choose
to help with pain. Specific instructions for the use of these therapies will be
discussed with you by the surgical team.
If you have an abdominal or chest incision, you will want to splint the area
with a pillow when you are coughing or deep breathing to provide support for
your incision. You will be given a pillow in the hospital. Continue to use it at
home when needed.
Last, make sure you are comfortable with your treatment plan. Talk to your
doctor and nurses about your concerns and needs. This will help avoid stress and
anxiety, which can make pain worse. Do not be afraid to ask questions.
How can I control pain at home?
You may be given prescriptions for pain medication to take at home. These
may or may not be the same pain medications you took in the hospital. Talk with
your doctor about which pain medications will be prescribed at discharge.
Preparation for Your Discharge:
Your doctors may have already given you your prescription for pain medication
prior to your surgery date. If this is the case, it is best to be prepared and
have your medication filled and ready for you when you come home from the
hospital. You may want to have your pain pills with you on your drive home if
traveling a long distance. Check with your insurance company regarding
prescription plan and coverage for your medication.
- If you haven't received your prescription for pain medication until after
the surgery, make sure a family member takes your prescription and either
gets it filled at one of the Cleveland Clinic Pharmacies on campus or soon
after your discharge from the hospital. It is important that you ARE
PREPARED in case you have pain.
- Make sure you wear comfortable clothes and keep your coughing and deep
breathing pillow with you.
- You may want to have your relaxation tapes and player available for your
travels.
- If you are traveling by plane, make sure you have your pain pills in your
carry-on luggage in case the airline loses your checked luggage.
While at Home:
- Remember to take your pain medication before activity and at bedtime. Your
doctor may advise you to take your pain medication at regular intervals (ie,
every 6 hours).
- Be sure to get enough rest. If you are having trouble sleeping, talk to
your doctor.
- Use pillows to support you when you sleep and when you do your coughing
and deep breathing exercises.
- Try using the alternative methods discussed earlier. Heating pads or cold
therapy, guided imagery tapes and massage can help relieve your pain.
NOTE: If you need to have stitches or staples removed and you are
still taking pain medications, be sure to have a friend or family member drive
you to your Clinic appointment. Commonly, you should not drive or operate heavy
equipment if you are taking pain medications. Check the label of your
prescription for any warnings or ask your doctor, nurse, or pharmacist.
Frequently asked questions
I'm nervous about getting "hooked" on pain pills. How do I
avoid this?
Studies have shown that the risk of becoming addicted to pain medication
after surgery is very small. If you have a previous history of substance abuse
(alcohol or any drug), talk with your doctors. They will monitor you closely
during the recovery process.
I am a small person and am easily affected by medicine. I am nervous
that a normal dose of pain medication will be too much for me. What should I do?
During recovery, your healthcare team will observe how you respond to
pain medication and make changes as needed. Be sure to communicate with your
doctors about any concerns you have. Also, be sure to discuss this issue with
your doctor prior to surgery.
I don't have a high tolerance for pain. I'm scared that the pain will
be too much for me to handle. What can I do?
Concern about pain from surgery is very normal. The most important thing
you can do is to talk with your surgeon and anesthesiologist about your
particular situation. Setting pain control goals with your doctors before
surgery will help them better tailor your pain treatment plan. Treating pain
early is easier than treating it after it has set in.
I normally take Tylenol if I get a headache. Can I still take Tylenol
for a headache if I'm on other pain medication?
Before taking any other medication, be sure to talk to your doctor. Some
of the medications prescribed for use at home contain Tylenol and if too much is
taken, you may get sick. In order to avoid getting too much of any medication,
discuss this issue with your doctor BEFORE you leave the hospital.
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