Overview:
Post-Surgery Pain
Pain management for post-operative pain involves multiple pain medications or analgesics, non-steroidal anti-inflammatory drugs, and local anesthetics.
Approximately 86% of patients who undergo some form of surgery in the U.S. report post-surgery or post-operative pain each year. Pain can range in intensity from mild to moderate, and in some cases, severe.
What causes post-surgery pain?
After any surgery or procedure, most patients will experience some sort of post-surgical pain. Ideally, post-operative pain is anticipated, and your physician/surgeon should provide options to manage any post-operative, acute pain. Post-surgery pain is usually triggered by the incision wounds, burns due to grafting, damage or disruption of internal organs, nerve damage and/or tissue damage. Post-surgery pain should be temporary (only lasting 2 to 5 days), and medication is usually sufficient to effectively manage post-surgery pain.
What are the types of post-surgery pain?
Pain after a surgical procedure is common, and post-surgery pain can be classified as: Nociceptive pain, Neuropathic pain, Referral pain, and Phantom limb pain.
Neuropathic pain
Any damage to nerve cells during surgery will cause neuropathic pain. Any damage to the brain or spinal cord causes central neuropathic pain, while pain in the peripheral nerves is called peripheral neuropathic pain.
Referred Pain
“Referred Pain” is pain perceived at a location other than the site of the painful stimulus. This is due to the network of interconnecting nerves supplying many different tissues.
Phantom limb pain
This type of post-surgical pain occurs where a patient continues to feel pain in a part of the body that has been amputated. For example, the patient might feel severe pain in a leg despite the leg being removed during surgery.
Nociceptive pain
Nociceptive pain is acute pain experienced when tissue is damaged during the surgery. This is the most common type of post-surgery pain, which subsides automatically as the region of the surgery begins to heal.
Nociceptive pain can be further classified as:
- Superficial somatic pain — Pain from superficial wounds (such as cuts, burns, or bruises on the skin) typically due to surgical incisions or grafting.
- Deep somatic pain — Pain caused when an incision cuts through internal tissue, tendon, ligament, or muscle.
- Visceral pain — Pain caused by cutting an internal organ.
How does post-surgery pain transition from acute to chronic pain?
Post-surgery pain is a common type of acute pain which refers to pain in the body after any major surgery. This type of pain can occur as “generalized” pain (all over the body) or “localized” pain (affecting specific parts of the body) after surgery. Post-surgery pain is almost always accompanied by other symptoms, such as:
- Insomnia
- Extreme sweating or lack of sweating
- Pain in joints and muscles
- Pain in the head and limbs
- Fatigue
- Loss of appetite
Post-operative pain may be acute the first 1 or 2 days after surgery as approximately 30% of patients will experience severe pain in the first 24 hours after even a minor surgery. Interventional pain management is sufficient to manage this surgical pain using pain medications, long-lasting local anesthetics, and pre-operative counseling.
In approximately 10% of patients, acute post-surgery pain evolves into a chronic pain condition where acute pain is not controlled with the usual pain management techniques and the patient becomes less responsive to pain medications. Chronic post-surgical pain can last for 2 months or longer, and if left untreated, can potentially lead to long-term disabilities and a reduced quality of life.
What factors increase the risk of post-surgery pain?
Acute and chronic post-surgery pain can increase based on certain risk factors, genetic markers and/or pre-existing medical factors.
Some of the common risk factors for post-surgery pain are:
- Pre-existing medical conditions such as fibromyalgia, migraines, irritable bowel syndrome, and Raynaud’s syndrome
- Pre-existing nerve conditions such as peripheral neuropathy
- Autoimmune diseases
- Increasing age
- Intensity of the acute postoperative pain
- Pre-existing chronic pain conditions
- Pain threshold and coping abilities
- Psychological distress
- Type of surgery
- Sleep disorders
When should I see a doctor?
Pain after surgery is anticipated and normal. Most patients after surgery will develop symptoms indicative of post-operative pain that include:
- Dehiscence or a break or separation in the surgical wound site
- Swelling around the surgery site(s)
- Soreness
- Constipation
- Fever
- Flatulence
- Nausea and/or vomiting
In some cases, complications such as a hemorrhage(s), wound site infection, pulmonary embolism, deep vein thrombosis, urinary retention, reaction to anesthetics, and pulmonary complications may arise. Signs of complications include:
- Mild to moderate pain at the incision or procedure site
- Accumulation of pus in the affected areas
- Collection of blood under the skin
- Swelling
- Change in bowel movements
- Formation of fistulas
- Weight loss
- Chest pain
Consult your physician if you are experiencing any of these symptoms.
There are several symptoms that can arise that are very serious where you should seek immediate medical attention (like a hospital or emergency room):
- Persistently high fever
- Unbearable pain
- Confusion
- Bleeding
- Shortness of breath
- Chest pain
- Lethargy
Again, if you are experiencing any of these symptoms seek medical attention immediately!
How is post-surgery pain diagnosed?
If you are experiencing pain after the surgery and multimodal treatments (including pain medications) are not providing effective pain relief, consult your surgeon or physician immediately. To assist with your post-surgery pain management, your physician should ask you the following information to describe the pain:
- Type of pain experienced – stabbing, sharp, burning, throbbing, etc.
- Movements or postures that increase the pain
- If the pain radiates to other locations
- Inability to perform daily functions
- Location of the pain
- Duration of the pain
- Severity of the pain
To evaluate your pain condition and determine an accurate diagnosis and treatment plan, your team of specialists at Advanced Pain Care will review and examine the following areas:
- Physical examination of the site of the surgery
- Past medical history and surgical history
- History of medications
The physician may also ask for specific tests to check for signs of infection, bleeding, accumulation of fluids, etc. These can include blood tests, X-rays, CT scans, and/or sonograms.
If the pain remains persistent after several weeks after a surgery, a physician should examine the following parameters to determine if post-operative pain has become a chronic postoperative pain condition. They include:
- All other causes of pain possibilities have been excluded
- The pain has been persistent for at least 2 months
- The pain developed after the surgery
- Signs of neuropathic pain
How is post-surgery pain treated?
Prior to surgery, your physician at Advanced Pain Care will guide you through the process of your surgery, pre-operative tips and post-operative pain management guidelines. This consultation will include detailed information regarding:
- Pain management medications and procedures that will be implemented after the surgery
- Expectations regarding the type and amount of pain after different types of surgeries
- Possible side effects of pain medications and/or integrated pain management techniques
- Possible complications/reactions with existing medications
- Managing conditions that may increase the chances of post-surgical pain
- The post-surgical recovery process
- Managing post-surgical anxiety
Pain management for post-operative pain comprises multiple pain-relieving medications or analgesics, non-steroidal anti-inflammatory drugs and/or local anesthetics. To reduce the amount and variety of pain after surgery, your surgeon at Advanced Pain Care will also take steps to manage the pain during the surgery itself. This will include delivery of pain management medications like:
- Intravenous pain medication
- Patient-controlled analgesia
- Epidural analgesia
- Spinal analgesia
- Wound infiltration analgesia
- Nerve blocks
Along with switching to oral pain medications after surgery, your surgeon will also recommend general post-surgical care instructions such as application of ice, rest, elevation, wound care, and rehabilitation.
If the pain persists, your doctor may change/revise pain medication and post-operative treatment and rehabilitation instructions. If the pain persists more than 2 months, it should be considered chronic postoperative pain, and you will be referred to a pain management specialist at Advanced Pain Care for further examination and treatment.
To effectively manage and treat chronic postoperative pain, pain management and pain medicine specialists treat the condition through a multimodal treatment plan which can include:
- Pain medications, non-steroidal anti-inflammatory drugs, anticonvulsants, and nerve blocks
- Structured rehabilitation and therapy programs
- Treatment of associated health conditions
How can post-surgery pain be prevented?
Post-surgery pain is an expected condition. Simple guidelines and instructions from your doctor can usually manage the pain effectively while helping your body to heal. You can often reduce postoperative pain by following these guidelines:
Pain after any surgery is common, although prolonged episodes of pain are not. The surgeons, physicians, and pain management specialists at Advanced Pain Care facilitate a multidisciplinary effort to ensure that you experience minimal pain after your surgery. Visit https://austinpaindoctor.com/ or call 512.244.4272 to schedule an appointment or learn more about how we address and manage post-surgery pain.
FAQS
Q: How long does post-surgical pain last?
A: Post-surgery pain should be temporary (lasting 2 to 5 days) and is managed using pain medications, anti-inflammatory drugs and/or local anesthetics. For minor surgical procedures, pain is anticipated to last from 1-2 days). For complex surgical procedures, pain is often experienced for a greater amount of time (usually 3-4 days). Proper pain management intervention(s) will initially help manage acute pain after surgery, with pain generally being relieved almost entirely within approximately 2 weeks.
Q: How do you relieve pain after surgery?
A: To reduce the levels of of pain after surgery, a surgeon should take steps to manage the pain during the actual surgery which will include delivery of pain management medications such as:
- Intravenous pain medication
- Patient-controlled analgesia
- Epidural analgesia
- Spinal analgesia
- Wound infiltration analgesia
- Nerve blocks
A surgeon will recommend switching to oral pain medication and provide general post-surgical care instructions such as application of ice, rest, elevation, wound care, and rehabilitation to control pain.
Q: Why is there pain after surgery?
A: Pain after a surgery is to be expected, and can be caused by a variety of factors, such as damage done to the tissue during the incision, closing of the wound, any force applied during the surgery and/or the shifting of organs during the procedure.
