Postop Pain

WHAT YOU SHOULD KNOW:

  • Postop pain is pain that you have after surgery. It is also called postsurgical or postoperative pain. Everyone feels pain differently and responds differently to pain control treatments. We used to think that severe pain after surgery was normal and to be expected. But, today there are treatments to prevent or control postop pain. It is important to keep your pain level low so that you are comfortable. This will help you to start moving sooner which helps you heal faster.

  • Pain after surgery is caused by injury to your skin, muscles, and nerves during the operation. How much surgery was done may affect how much pain you have afterwards. Another thing that makes postop pain worse is having gas in your bowel (gut or intestine). Being anxious or worrying can also make postop pain worse. Tell caregivers about your pain so that they can help you manage it. Caregivers want to lessen your suffering. Following are some of the other reasons why it is important to control pain after surgery.

    • Pain affects how well you sleep which makes you feel like you do not have any energy. And, if you have too much pain you may not be able to do the things that help you heal faster, like sitting in a chair or walking.

    • Pain can also cause you to breathe too shallow and may keep you from coughing. This can lead to pneumonia.

    • Pain can affect your appetite (desire to eat) and can keep your bowels from working normally. This may make you not eat after surgery. Good nutrition is very important in helping you heal well.

    • Pain can also affect your mood (how you feel about things) and your relationships with others.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

If your pain is not treated, it may cause other health problems. Let your caregiver know when you are having pain. Talk to your caregiver if you have questions or concerns about your pain, medicines, or care.

WHILE YOU ARE HERE:

  • Controlling the Pain: Caregivers want you to talk to them about your pain. This helps them learn how best to treat it. Caregivers will ask many of the following questions before, during, and after pain control treatments to learn more about your pain. These questions help them know whether you feel that your pain is under control.

    • Where does it hurt? Where does it not hurt? Is the pain just in your incision (cut) or does the pain move from one area to another?

    • How would you rate the pain on a scale of 1 to 10? (0 is no pain, and 10 is the worst pain you ever had.)

    • How does the pain feel? Try to choose words that tell caregivers what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, or crushing? Or, is the pain stabbing, burning, dull, numb, or "pins-and-needles" feeling?

    • When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?

    • Does the pain wake you from sleep?

    • Do certain things or activities cause the pain to start or get worse like coughing or touching the area?

    • Does the pain come before, during, or after meals?

    • Does anything lessen the pain like changing positions, resting, medicines, or changing what you eat?

  • Medicine:

    • Anti-Anxiety Medicine: This medicine may be given to help you feel less nervous. It may be given by IV, as a shot, or by mouth. Lessening your anxiety can help lessen your pain.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • NSAIDs: These medicines, such as ibuprofen, lessen inflammation which helps lessen pain. Caregivers may give you one of these medicines in addition to other pain medicine to help keep your pain under control.

    • Pain medicine: After surgery you may be given 1 or more different types of pain medicine. They work together so that less medicine is needed while getting better pain control than any single type of medicine. Pain medicine may not get rid of pain completely. But, it should keep it at a level that allows you to move around, eat, and breathe easily. Do not wait until your pain is too bad to ask for medicine. The medicine may not work as well at controlling the pain if you wait too long. Tell caregivers if the pain does not go away or comes back. Following are the different ways pain medicine can be given.

      • By mouth: You may be given pills or liquid to swallow or you may be given a pill or liquid to put under your tongue.

      • Epidural : Medicine is given through a catheter (tube ) that caregivers put into epidural space (the area around the spinal cord).

      • Intranasal: Medicine is absorbed (soaked up) by the nasal mucosa (skin inside the nose) and then moves into the blood stream.

      • Nerve block: A shot of medicine is put close to the nerves in the area that hurts to break the pain cycle. The medicine makes the nerves unable to send pain messages to your brain. Nerve blocks give short-term relief of pain so that you can use the painful part and have a more normal life.

      • PCA: A PCA is a device to give you pain medicine. PCA stands for patient-controlled analgesia . This electric pump has pain medicine which is connected through a tube to an IV (in your vein) or sub-q (under your skin). You press a button when you feel pain and you receive medicine from the pump through the tube. Caregivers have set the pump so you cannot get too much medicine. A PCA pump works well to control pain because you can give yourself medicine before the pain gets too bad. Being in control of your pain relief also helps you relax and deal with the pain better.

      • Rectal: Medicine in a suppository is put into your rectum.

      • Shot: Pain medicine can be given as a shot in an IV, into a muscle, or under the skin (sub-q).

      • Topical: Medicine in a cream or gel is spread over your skin.

      • Transdermal: Some medicine can be given as a patch put on the skin. This medicine is released slowly to give pain relief for as long as 72 hours.

  • Pain Control Techniques help you deal with pain instead of taking it away. It is important to practice the technique when you do not have pain if possible. This will help the technique work better during an attack of pain.

    • Activity: It is important to start moving as soon as possible after surgery. Moving helps your breathing and digestion and helps you heal faster. But, it may hurt to move even though moving and being active actually helps lessen pain over time.

      • At first you may need to rest in bed with your upper body raised on pillows. This helps you breathe easier and may help lessen pain. Caregivers will help you get out of bed or at least sit on the side of your bed, probably the day of surgery.

      • Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.

    • Cold and Heat: Both cold and heat can help lessen some types of postop pain. Some types of pain improve best using cold while other types of pain improve most with heat. Caregivers will tell you if cold and/or hot packs will help your pain.

    • Deep Breathing and Coughing: This breathing exercise helps keep you from getting a lung infection after surgery. But, the exercise may make the pain worse while you are doing it. Holding a pillow firmly against your incision can help lessen the pain. Even if it hurts, you should do this exercise every hour while you are awake. Remember to follow each deep breath with a cough unless caregivers tell you not to cough because of the kind of surgery you had.

      • Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths and coughs in a row every hour while awake.

      • You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.

    • Distraction teaches you to focus your attention on something other than pain. Playing cards or games, talking and visiting with family may relax you and keep you from thinking about the pain. Watching TV or reading may also be helpful.

    • Elevation: You may need to raise or "elevate" the incision (if it is in your arm or leg) higher than your heart. This helps to lessen the pain and swelling and improve the blood flow. It can also help the injury heal faster.

    • Music. It does not matter whether you listen to music, sing, hum or play an instrument. Music increases blood flow to the brain and helps you take in more air. It increases energy and helps change your mood. Music may also cause your brain to make endorphins which further lessens pain.

    • Relaxation Techniques: Stress and anxiety can make pain worse and may slow healing. Since it is hard to avoid stress, learn to control it. Caregivers will help you use different ways to relax. Ask caregivers for more information on deep breathing, relaxing muscles, meditation, or biofeedback.

      • Comfort Measures:

        • Caregivers will help you get as comfortable as possible in bed. Ask for more pillows or blankets if you need them.

        • Tell your caregiver if the temperature in the room is OK for you.

        • Having your back rubbed may help you relax and lessen your pain.

        • You may feel better by putting a cool cloth on your hands or face.

      • Controlling Sound and Noise:

        • Keep the lights and noise in your room as low as possible.

        • Ask your caregiver to pull the curtain around your bed. This will lessen interruptions so that you can relax and rest better.

    • Physical therapy can be helpful with pain that was caused by not moving one part of your body or after surgery or an accident. Stretching the muscles and making them stronger around the injured area can help the pain go away.

    • Self-hypnosis is a way to change your level of awareness. This means that by focusing your attention you can move away from your pain. You make yourself open to suggestions like ignoring the pain or seeing the pain in a positive way. It is not known exactly how hypnosis helps pain. But, hypnosis can give long-lasting relief of pain without affecting your normal activities. Self-hypnosis gives you better control of your body. You may feel less hopeless and helpless because you are doing something to lessen the pain.

    • TENS is short for transcutaneous electrical nerve stimulation. A TENS unit is a portable, pocket-sized, battery-powered device which attaches to the skin. The TENS unit uses mild, safe electrical signals to help control pain.

    • Spinal cord stimulation is a nerve stimulation technique that is similar to TENS. The difference is that in SCS an electrode (a metal wire) is put near the spinal cord during surgery. SCS also uses mild, safe electrical signals to help control pain.

  • Vital Signs: Caregivers may measure your vital signs often because pain can make your blood pressure and pulse change. And, the amount of oxygen in your blood can drop if you are not breathing well because of the pain. To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure and pulse reading. The amount of oxygen in your blood may also be measured using a machine called a pulse oximeter. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine so caregivers can see if you need more oxygen.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Postop Pain (Inpatient Care)

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