Pain after surgery: How pain medications and anesthesia can help

You don't have to suffer through severe pain after surgery. Modern pain medications and anesthesia can control post-surgical pain and help your body heal.

If you're scheduled for surgery, it's natural to have concerns — or even fears — about the pain following the procedure. Although some pain is likely, you don't have to endure severe pain after any surgery. In fact, your nurses and doctors consider effective pain management a key part of your recovery, because well-controlled pain can speed your healing and lead to fewer complications.

The best treatment for post-surgical pain requires a careful balance between benefits and risks. If your pain medication is too strong, you may have side effects, such as sleepiness, nausea or vomiting. But if your pain medication is too weak, you may suffer unnecessary pain. The goal is finding the right balance for you at each point during the procedure and during your recovery.

Plan now for post-surgical pain relief

The time to talk about post-surgical pain relief isn't after surgery. Here's how to start:

• Discuss previous experiences with pain. Before surgery, talk to your doctor about your experience with different methods of pain control. Mention what worked for you and what didn't.
• Talk about chronic pain. If you have chronic pain, you'll likely have to deal with that pain, in addition to the post-surgical pain. And your body may be less sensitive to pain medication — a phenomenon called tolerance — if you're taking medications for chronic pain. Discuss this in detail with your doctor before surgery.
• Be honest about your alcohol and drug use. Tell your doctor if you are a recovering alcoholic or drug abuser. If so, you can plan for pain control that minimizes the risks of relapse. If you're currently abusing alcohol or drugs — even legal drugs, such as benzodiazepines — let your doctor know. Withdrawing from these substances can be difficult, and the post-surgical period is not the time to try it.
• Make a list of your medications. Include all prescription and over-the-counter medications, plus any supplements or herbs you've taken in the past month. Your doctor needs to know about anything that might interact with post-surgical pain medications. Be sure to list any pain pills you take on a regular basis, because your body may be tolerant to their effects and require higher than usual doses to achieve adequate pain control. In most cases, you can take your regular medications with a sip of water on the morning of your procedure, but confirm this with your doctor.
• Ask questions. Find out how severe the pain typically is after this type of surgery, and how long it lasts. What kind of pain medications will be given before and after surgery? What are the possible side effects of these medications? What can be done to minimize side effects?

After surgery, you'll need to communicate with your doctors and nurses. Controlling your pain is important to them, too.

• Be honest about the pain you feel after surgery. Let your doctors and nurses know how much it hurts and where it hurts. Pain often changes through the day and night, and with activity. Your medical team may ask you to rank your pain on a scale of 0 to 10, with zero meaning no pain and 10 being the worst pain you can imagine. Don't downplay what you're feeling. Your honesty will help control your pain. The more specific you can be, the better your doctors can help you.
• Don't ignore side effects. Tell your care team if you experience sleepiness, constipation, nausea or other side effects of the medications. A different pain medication or dose can sometimes reduce uncomfortable side effects.

Postoperative pain control usually involves a succession of different medications and routes of administration — beginning with the most intense efforts to relieve pain during and right after surgery and moving to less-powerful, oral medications by the time you go home. Of course, if you undergo major surgery — such as chest surgery, abdominal surgery or joint replacement — your recovery will probably start at the top of the list of pain relief options. For minor operations — such as dental work or skin lesion removals — you'll likely skip the most potent strategies and start somewhere in the middle. What follows are some of the most common options.

Intense pain relief for the hospital or recovery room

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	Illustration showing placement of epidural catheter
	Patient-controlled analgesia (PCA)

Doctors rely on these powerful pain medications to relieve acute pain immediately after surgery. These techniques are typically used until you're able to take medications by mouth.

Epidural analgesia
This form of pain relief is most commonly used for labor and delivery — including Caesarean section. It's also common for chest surgery involving the lungs and, infrequently, it may be used for hip or knee surgery.

In epidural analgesia, medications are injected through a long, thin tube (catheter) inserted into the epidural space within your spinal canal but outside your spinal fluid. An epidural catheter is often placed into your back shortly before a major operation and left in place for several days. A continuous infusion of pain relievers — including numbing medications (local anesthetic) and opioid medications, such as morphine and codeine — can be delivered through the catheter to eliminate pain from the neck down.

Neuraxial opioids
Some surgeries can be done with spinal anesthesia. Unlike epidural analgesia, this form of pain relief involves medications injected directly into the spinal fluid. This is common for Caesarean section and many urological procedures. And your doctor can add a long-acting opioid to the spinal medication that can relieve post-surgical pain for up to 24 hours.

Nerve blocks
Nerve blocks can provide targeted pain relief to your extremities, so they're often used for surgery involving your hips, legs, shoulders or arms. They prevent pain messages from traveling up the nerve pathway to your brain. If you only need a few hours of pain relief, your anesthesiologist may use a single injection of local anesthetic around the appropriate nerves related to your surgery. For longer pain relief, your anesthesiologist may thread a catheter into that area to deliver a continuous infusion of pain medications. Nerve blocks can be used for outpatient procedures or more-involved inpatient surgery. Sometimes you may even go home with a nerve block catheter attached to a pump that provides ongoing pain relief.

Intravenous (IV) pain medications
Before surgery, you'll probably have a slender plastic tube inserted into a vein in your hand or arm to give you fluids, anesthetics, antibiotics or pain medications. After surgery, your doctor may keep this intravenous (IV) catheter in place to deliver pain medications while you're in the hospital or outpatient recovery room.

Pain relievers, such as opioids, are usually injected into your IV at regular intervals. Most hospitals also offer patient-controlled analgesia (PCA) — a system that allows you to give yourself a fixed dose of the medication by pushing a button. This way you don't have to ask your nurse for each dose of pain medicine.

The PCA system has built-in safeguards to prevent you from overdosing on pain medication. If you push the button more than once within a set period of time, the dispenser ignores your request. This gives each dose of pain medicine enough time to work before you receive another dose. Also, when there's more medication than you need in your bloodstream, you become too sleepy to press the button. When you're no longer drowsy from medication, you'll be able to safely give yourself another dose. That's why you should never press the PCA button for a sleeping friend or family member. No one but the person receiving the medication should ever administer a dose.

Less-potent pain relief for minor surgery and home recovery

For minor surgery, these tactics are all you need to control your pain. For major surgery, they are usually the last step on the road to healing.

Local anesthetics
Your doctor may inject local anesthesia directly into a wound or surgical incision, using a very small needle. This numbing medication blocks pain in a small area of the body, so it's often used for dental work or minor skin procedures. This form of pain relief doesn't last long, but it can help reduce the need for other pain medications. It's also possible to go home with a catheter that delivers local anesthetics.

Oral medications
You'll probably be switched to oral medications in the hospital and continue taking them during your first few days — or weeks — at home.

• Opioid analgesics. Also known as narcotics, these medications may be injected around your nerves or into your veins immediately after surgery. But they can also be taken in pill form once you're eating regularly. Oral opioids work well on severe pain, but the relief can come with side effects, including drowsiness, nausea and constipation. Despite common myths, opioids have a low risk of addiction, when taken exactly as directed.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Traditional NSAIDs — such as ibuprofen (Advil, Motrin, others) — can reduce swelling, soreness and minor pain. They may be used after minor procedures, such as tooth-pulling or skin biopsy. They may also be combined with opioids for treatment after some arthroscopic surgeries or home recovery after major surgery. Combining NSAIDs with opioids maximizes pain relief with lower doses of opioid medications, which causes fewer side effects.

Remember: When your pain is under control, your body can focus on the important work of healing. So this isn't the time to test your pain tolerance or grin and bear it. Work with your health care team to make your recovery as prompt and pain-free as possible.