Are you anxious about how much discomfort or pain you may experience after an upcoming surgery? Do you have concerns about taking a pain medication and the side-effects you may experience?
“It’s normal for patients to have concerns about pain following a surgical procedure,” says David H. Rahm, M.D., board certified anesthesiologist and VitaMedica founder. “My advice is to discuss the possibility of post-operative pain with your doctor at the pre-op visit. Ask what medications or modalities will be available to manage any post-op pain that you may experience.”
Dr. Rahm continues, “Your anesthesiologist will ensure that you are comfortable during your procedure and will likely manage any discomfort you experience in the recovery area. And, your surgeon will prescribe an analgesic medication to control pain after you are discharged from the hospital or surgery center.”
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Developing a Pain Treatment Plan
A number of intravenous and oral pain medications are available. A newer method of pain management called multi-modal therapy combines medications or other methods to decrease the opioid dose you need to control pain.
Certain medical conditions such as sleep apnea, anxiety or depression, chronic pain or drugs and alcohol addiction, can complicate pain management. Be sure to discuss these health issues with your doctor before surgery.
Ultimately, your surgery, medical history and tolerance for pain will determine which pain medication regimen is best suited for your needs.
Intravenous Medications to Control Pain
For surgeries isolated to a smaller area of the body (e.g., arm or leg), your anesthesiologist may use a nerve block to control your pain. The advantage is that you get pain control both during and after your surgery. Also, by mitigating the need for strong pain medications, a nerve block may also reduce your risk of nausea and vomiting after surgery – a common side effect of narcotics.
For more comprehensive surgeries, your doctor may offer patient-controlled analgesia (PCA). By pushing a button, PCA allows you to administer measured doses of pain medicine through a small pump and an intravenous line. You don’t have to worry about giving yourself too much medication as a computerized pump will not allow an overdose to be delivered.
Dr. Rahm adds, “Many patients like the sense of control they get with a PCA device. With this type of pain management, patients can typically administer a dose of medication before the previous dose has begun to wear off. This often reduces the total amount of pain medication that is administered in a 24-hour period.”
Oral Medications to Control Pain
The oral medications used for pain management include opioids (narcotics), non-narcotic analgesics and non-steroidal anti-inflammatory drugs (NSAIDs).
Opioid Drugs – Narcotics. Opioids can be given after surgery (e.g., morphine, fentanyl, and hydromorphone) or prescribed for when you return home (e.g., Percocet® and Vicodin®). Opioids are best used for short-term pain relief after surgery.
While opioids are strong pain relievers, they can cause significant side-effects like nausea, vomiting, itching, drowsiness and/or constipation.
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Like many patients, you may be concerned about becoming addicted or habituated to opioids. And, a recent study found that for 7 common surgeries including total knee replacement, gallbladder removal and cesarean delivery, the risk of developing an opioid addiction was slightly increased.
“Treatments used for post-op pain are relatively safe but they are not completely risk free. But the overall risk of opioid abuse becoming a chronic problem is still low – probably less than 0.5%. Nevertheless, physicians should closely monitor patients’ opioid use in the period after surgery.” says Dr. Rahm.
Non-Narcotic Analgesics. If your pain is mild to moderate, non-narcotic analgesics like acetaminophen (Tylenol®) are a good solution. These types of analgesics have fewer side-effects than narcotic drugs. However, many opioid medications also contain acetaminophen, so use caution when consuming additional acetaminophen as this medication can cause liver damage.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). This class of drugs help to control pain, swelling and inflammation. NSAIDs include aspirin, ibuprofen (Advil®, Motrin®), naproxen (Aleve®) and celecoxib (Celebrex®). Unlike opioids, you don’t need to worry about addiction. But, these drugs have a blood thinning effect so you can’t take them in combination with a blood thinner (e.g., Coumadin®, Plavix®). A problematic side-effect associated with NSAIDs is stomach bleeding and kidney problems especially with their long-term use. Because of their effect on the kidneys NSAIDs can also make high blood pressure more difficult to control.
How to Manage Post-Op Pain
Like most things in life, being prepared and knowing what to expect is the best way to manage post-op pain. Here are a few suggestions from Dr. Rahm:
Get your meds in advance. Your doctor will prescribe the pain meds you need to take after surgery. Make sure that you purchase these in advance and have them ready once you return home.
Manage your expectations. Prior to having surgery, speak with your doctor about what level and type of pain you should expect. Some surgeries like total hip replacement, tummy tuck and gallbladder removal can be more painful than others.
Keep your pain under control. Don’t wait to take your pain medication until your pain is severe or much more medicine will be needed for relief. “Keep your level of pain at a more moderate and manageable level,” says Dr. Rahm. Most pain medications are taken every four hours. These medications are also taken before activity and bedtime. Treating pain early usually brings quicker and better control and reduces the overall dose needed for pain medications.
Watch for side-effects. If you’ve had problems taking a pain medication in the past, inform your doctor. If you’re experiencing significant side-effects such as nausea, let your doctor know so he can modify your pain management regimen.
Calm your nervous system. You don’t always have to take a medication to relieve pain. Whether it’s listening to music, diaphragmatic breathing, progressive muscle relaxation or mindful meditation, each of these techniques can help to control your nervous system and pain.
Use hot or cold therapy. Heat or cold packs can help to control pain and swelling. Check with your doctor what is the most appropriate method to use.
Dr. Rahm says, “You’ll feel more in control by taking an active role in your post-surgical pain management. More importantly, good pain control can help speed your recovery and reduce your risk of developing complications after surgery.”
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.