Download Pain following surgery or injury

Pain following surgery or
injury
A guide for patients and carers
Department of trauma and orthopaedics, plastics,
physiotherapy and occupational therapy
This leaflet provides information to patients and their
families on understanding and managing their pain
whilst in hospital. If you have any further questions,
please speak to a doctor or nurse caring for you.
What is pain?
Pain is an unpleasant sensation which occurs in response
to actual or potential damage to part(s) of your body. Many
different words are used to describe pain, for example
‘aching’, ‘dull’, ‘shooting’, ‘burning’, ‘stabbing’ and ‘stinging’.
The way pain is felt and described is different for each
individual.
Pain can be either acute or chronic.

Acute pain occurs immediately following an injury,
for example a broken bone or an operation. This is
our body’s way of signalling danger; causing you to
stop, rest and seek treatment, and therefore
promoting healing. It can last from a few seconds to
three months. It is a normal response and will
improve as healing takes place.

Chronic (persistent) pain lasts longer than three
months – beyond the normal healing time of most
injuries. This pain is not useful and can lead to
longer-term disability and problems with function
and movement.
Poorly controlled acute pain is the biggest risk factor for
chronic pain. It is therefore very important to effectively
manage your pain in the early stages whilst you are still in
hospital and recovering at home.
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Why do we feel pain?
Pain is a danger signal to your brain. When your nerve
endings are stimulated it may trigger a sensation or feeling.
If this stimulus goes above a certain threshold, that
sensation is felt as pain. If we did not experience pain we
would be in danger of doing ourselves further harm as we
would not know that our body had been injured.
How bad is my pain?
Your nurse may ask you to rate your pain as mild,
moderate or severe. You may be asked whether there is a
difference between your pain levels when you are resting,
and your pain levels when you are moving. You may also
be asked to rate your pain on a scale of zero to 10. A score
of zero would indicate no pain at all, whereas 10 would
indicate the worst pain imaginable (unbearable pain).
There is no ‘normal’ amount of pain following a certain
injury or operation – everybody experiences and rates their
pain differently. It is important that you let your doctors,
nurses and therapists know if you are in a lot of pain, as
they can help you to manage it more effectively.
How can I manage my pain?
Pain-relieving medications (also called ‘analgesics’ or
‘painkillers’) may be given orally (tablets and medicines), in
patches, as an injection or through a drip. Different types of
painkillers are effective for different sorts of pain. For
example, some painkillers target pain from nerves whilst
others are effective for muscular or joint pain. Your
medications will be reviewed by your hospital team to
ensure you are getting the most effective pain relief,
however it is rare that painkillers will stop you from feeling
any pain at all.
Sometimes you may be prescribed regular pain relief as
well as another type of pain relief that can be requested as
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and when it is needed (before a physiotherapy session, for
example). This second type of pain relief may take around
thirty minutes to be effective. It is important that you ask for
these painkillers because if your pain is preventing you
from moving, it is preventing you from getting better.
There are many other ways of controlling pain besides
medication and we encourage you to take an active role in
managing your own pain. Below are some methods you
can use:
Ice
Ice can be used to reduce swelling and inflammation. Your
physiotherapist may supply you with a cryocuff (a re-usable
ice pack) or you can use a bag of crushed ice or frozen
vegetables at home. It is recommended that you use the
ice for 15–20 minutes, three times a day. Never place the
ice directly on your skin – wrap it in a towel and check your
skin regularly for marking/ice burns.
Elevation
Keeping your painful limb higher than the level of your
heart will encourage drainage of any swelling, which can
help to reduce your pain.
Movement, positioning and exercise
Your physiotherapist and/or occupational therapist will
teach you exercises to keep the muscles surrounding your
injury strong and prevent your joints becoming stiff. Moving
the area and regularly changing your position will also help
to reduce your pain. It is important to pace yourself when
you resume walking or begin new exercises – start slowly
and exercise ‘little and often’, gradually increasing how
much you do each day. Practicing functional activities,
such as making a cup of tea or showering, can also help
you to manage your pain once you go home and return to
everyday activities.
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Heat
Sometimes heat can be more effective in relieving pain
than ice. Heat can be beneficial for muscular aches and
pains where there is no swelling. You can use a ‘heat pad’
or hot water bottle for 15–20 minutes, three times a day.
Heat should not be used on wounds or where there is
swelling following an operation.
Acupuncture
Acupuncture uses small needles placed at certain points
on the body to relieve pain that is not responding to other
treatment. Your physiotherapist can discuss this option
with you and will decide if it is appropriate for your type of
pain.
Transcutaneous electrical nerve stimulation (TENS)
TENS uses a small electrical current through pads placed
on the skin to help block pain signals to your brain. It can
be effective in relieving persistent pain. Your team can
discuss TENS with you and help to decide if it is an
appropriate treatment for you.
Massage
Sometimes an injured area can become hypersensitive to
normal touch, meaning that your threshold for pain is lower
than normal. This can be due to many factors including
increased firing of nerves and increased inflammatory
chemicals in the area. It is possible to desensitise the area
by using gentle massage, touching the area with different
materials/textures and rubbing in moisturiser or cream.
Distraction and relaxation techniques
Feeling anxious or scared of the pain may make it feel
even worse. Distracting yourself by doing normal day-today activities, talking to friends or being away from the
ward for short periods of time can help you to control your
pain better. Reducing your anxiety through relaxing
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breathing techniques, listening to music or watching a film
can also help.
What if my pain gets worse?
Pain is a normal response to injury or surgery. However,
you should inform your healthcare team if your pain
suddenly increases without any obvious trigger.
Sometimes a sudden increase in pain may be due to
changes in your activity levels as advised by your
physiotherapist and/or occupational therapist. Sometimes,
however, it can indicate that something is not right and
appropriate investigations may need to be carried out.
Remember, if you don’t inform us that you are in
excessive pain, we cannot help you to manage it.
Contact us
If you have any questions or concerns about the
medications you have been prescribed for your pain,
please speak to your pharmacist or pain nurse. You can
also call the Medicines Information Patient Helpline on
020 8725 1033 (9.30am to 5.30pm, Monday to Friday). For
further information about non-medical pain management,
please speak to your physiotherapist. If your pain
continues, please consult your GP. For persistent pain your
GP can refer you to a multidisciplinary pain management
programme.
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Notes
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Additional services
Patient Advice and Liaison Service (PALS)
PALS can offer you on-the-spot advice and information
when you have comments or concerns about our
services or the care you have received. You can visit the
PALS office between 9am and 5pm, Monday to Friday in
the main corridor between Grosvenor and
Lanesborough Wing (near the lift foyer). Tel: 020 8725
2453 Email: [email protected]
NHS Choices
NHS Choices provides online information and guidance
on all aspects of health and healthcare, to help you
make decisions about your health.
Web: www.nhs.uk
NHS 111
You can call 111 when you need medical help fast but
it’s not a 999 emergency. NHS 111 is available 24 hours
a day, 365 days a year. Calls are free from landlines
and mobile phones. Tel: 111
Reference: THE_PFS_01
Published: February 2015
Review date: February 2017
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