Download This booklet talks about pain relief after surgery. It explains the goals

This booklet talks about pain relief after surgery. It explains the goals of pain control and the types of
treatment you may receive. It also shows you how to work with your doctors and nurses to get the best pain
control. Reading the booklet should help you:
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Learn why pain control is important for your recovery as well as your comfort.
Play an active role in choosing among options for treating your pain.
Treatment Goals
People used to think that severe pain after surgery was something they "just had to put up with." But with
current treatments, that's no longer true. Today, you can work with your nurses and doctors before and after
surgery to prevent or relieve pain. Pain control can help you:
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Enjoy greater comfort while you heal.
Get well faster. With less pain, you can start walking, do your breathing exercises, and get your strength
back more quickly.
Improve your results. People whose pain is well controlled seem to do better after surgery. They may
avoid some problems (such as pneumonia and blood clots) that affect others.
Pain Control:
What are the options?
Both drug and non-drug treatments can be successful in helping to prevent and control pain. The most
common methods of pain control are described below. You and your doctors and nurses will decide which
ones are right for you. Many people combine two or more methods to get greater relief.
Don't worry about getting "hooked" on pain medicines. Studies show that this is very rare Ð unless you
already have a problem with drug abuse.
Pain Control Methods You May be Using
To get the best results, work with your doctors and nurses to choose the methods that will work best for
you.
Your nurses and doctors want to make your surgery as pain free as they can. But you are the key to getting
the best pain relief because pain is personal. The amount or type of pain you feel may not be the same as
others feel Ð even those who have had the same operation.
Before Surgery
Drug treatment: Take pain medicine as ordered by your physician. Non-drug treatment: Understand what
operation the doctor is doing, why it is being done, and how it will be done. Learn how to do deep breathing
and relaxation exercises.
During Surgery
Drug treatment: Take pain medicine as a pill, shot, or suppository, or through a tube in your vein or back (a
tube in your back is called an epidural).
After Surgery Non-drug treatment:
Use massage, hot or cold packs, relaxation, music or other pastimes that distract you, positive thinking, or
nerve stimulation (TENS).
What can you do to help keep your pain under control?
These seven steps can help you help yourself:
Before Surgery
1. Ask the doctor or nurse what to expect.
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Will there be much pain after surgery?
Where will it occur?
How long is it likely to last?
Being prepared helps put you in control. You may want to write down your questions before you meet
with your doctor or nurse.
2. Discuss the pain control options in this booklet with your doctors and nurses. Be sure to:
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Talk with your nurses and doctors about pain control methods that have worked well or not so well for
you before.
Talk with your nurses and doctors about any concerns you may have about pain medicine.
Tell your doctors and nurses about any allergies to medicines you may have.
Ask about side effects that may occur with treatment.
Talk with your doctors and nurses about medicines you take for other health problems. The doctors and
nurses need to know, because mixing some drugs with some pain medicines can cause problems.
3. Talk about the schedule for pain medicines in the hospital. Some people get pain medicines in the
hospital only when they call the nurse to ask for them. Sometimes there are delays, and the pain gets
worse while they wait. Today, two other ways to schedule pain medicines seem to give better results.
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Giving the pain pills or shots at set times. Instead of waiting until pain breaks through, you receive
medicine at set times during the day to keep the pain under control.
Patient controlled analgesia (PCA) may be available in your hospital. With PCA, you control when you
get pain medicine. When you begin to feel pain, you press a button to inject the medicine through the
intravenous (IV) tube in your vein.
For both ways, your nurses and doctors will ask you how the pain medicine is working.
4. Work with your doctors and nurses to make a pain control plan. Plan for pain control with your
nurses and doctors. They need your help to design the best plan for you.
After Surgery
5. Take (or ask for) pain relief drugs when pain first begins.
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Take action as soon as the pain starts.
If you know your pain will worsen when you start working or doing breathing exercises, take pain
medication first. It's harder to ease pain once it has taken hold. This is a key step in proper pain control.
6. Help the doctors and nurses "measure" your pain.
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They will ask you to rate your pain on a scale of 0 to 10. Or you may choose a word from a list that best
describes the pain.
You may also set a pain control goal (such as having no pain that's worse than 3-4 on the scale).
Reporting your pain as a number helps the doctors and nurses know how well your treatment is working
and whether to make any changes.
7. Tell the doctor or nurse about any pain that won't go away.
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Don't worry about being a "bother".
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Pain can be a sign of problems with your operation.
The nurses and doctors want and need to know about it.
Stick with your pain control plan if it's working. Your doctors and nurses can change the plan if your pain
is not under control. You need to tell the nurses and doctors about your pain and how the pain control
plan is working.
EXAMPLE – SLOW RHYTHMIC BREATHING FOR RELAXATION
1.
2.
3.
4.
5.
6.
7.
Breathe in slowly and deeply.
s you breathe out slowly, feel yourself beginning to relax; feel the tension leaving your body.
Now breathe in and out slowly and regularly, at whatever rate is comfortable for you. You may wish to
try abdominal breathing. If you do not know how to do abdominal breathing, ask your nurse for help.
To help you focus on your breathing and breathe slowly and rhythmically: Breathe in as you say silently
to yourself, "in, two, three." Breathe out as you say silently to yourself, "out, two, three" or each time you
breathe out, say silently to yourself a word such as peace or relax.
You may imagine that you are doing this in a place that is very calming and relaxing for you, such as
lying in the sun at the beach.
Do steps 1 through 4 only once or repeat steps 3 and 4 for up to 20 minutes.
End with a slow deep breath. As you breathe out, say to yourself "I feel alert and relaxed."
Additional points: If you intend to do this for more than a few seconds, try to get in a comfortable position in
a quiet place. You may close your eyes or focus on an object. This breathing exercise may be used for only
a few seconds or for up to 20 minutes.
*From: McCaffery, M. and Beebe, A. (1989). Pain: Clinical manual for nursing practice. St. Louis: C.V.
Mosby Company.
0-10 NUMERIC PAIN INTENSITY SCALE
Chandler Regional Hospital uses two pain scales. You may use either scale when describing your pain.
BENEFITS AND RISKS OF PAIN TREATMENT METHODS
This information is provided to help you discuss your options with your doctors and nurses. Sometimes it is
best to combine two or more of these treatments or change the treatments slightly to meet your individual
needs. Your doctors and nurses will discuss this with you.
PAIN RELIEF MEDICINES
Nonsteroidal anti-inflammatory drugs Acetaminophen (for example, Tylenol), aspirin, ibuprofen (for
example, Motrin), and other NSAIDs reduce swelling and soreness and relieve mild to moderate
pain.
Benefits: There is no risk of addiction to these medicines. Depending on how much pain you have, these
medicines can lessen or eliminate the needs for stronger medicines (for example, morphine or another
opioid).
Risks: Most NSAIDs interfere with blood clotting. They may cause nausea, stomach bleeding, or kidney
problems. For severe pain, an opioid usually must be added.
Opioids Morphine, codeine, and other opioids are most often used for acute pain, such as shortterm pain after surgery.
Benefits: These medicines are effective for severe pain, and they do not cause bleeding in the stomach or
elsewhere. It is rare for a patient to become addicted as a result of taking opioids for postoperative pain.
Risks: Opioids may cause drowsiness, nausea, constipation, itching, or interfere with deep breathing or
urination.
Local anesthetics
These drugs (for example, bupivacaine) are given, either near the incision or through a small tube in your
back, to block the nerves that transmit pain signals.
Benefits: Local anesthetics are effective for severe pain. Injections at the incision site block pain from that
site. There is little or no risk of drowsiness, constipation, or breathing problems. Local anesthetics reduce
the need for opioid use.
Risks: Repeated injections are needed to maintain pain relief. An overdose of local anesthetic can have
serious consequences. Average doses may cause some patients to have weakness in their legs or
dizziness.
METHODS USED TO GIVE PAIN RELIEF MEDICINES
Tablet or liquid Medicines given by mouth (for example, aspirin, ibuprofen, or opioid medications
such as codeine).
Benefits: Tablets and liquids cause less discomfort than injections into muscle or skin, but they can work
just as well. They are inexpensive, simple to give, and easy to use at home.
Risks: These medicines cannot be used if nothing can be taken by mouth or if you are nauseated or
vomiting; sometimes these medicines can be given rectally (suppository form). There may be a delay in
pain relief, since you must ask for the medicine and wait for it to be brought to you; also, these medicines
take time to wear off.
Injections into skin or muscle
Benefits: Medicine given by injection into skin or muscle is effective even if you are nauseated or vomiting;
such injections are simple to give.
Risks: The injection site is usually painful for a short time. Medicines given by injection are more expensive
than tablets or liquids and take time to wear off. Pain relief may be delayed while you ask the nurse for
medicine and wait for the shot to be drawn up and given.
Injections into the vein
Pain relief medicines are injected into a vein through a small tube, called an intravenous (IV) catheter. The
tip of the tube stays in the vein.
Benefits: Medicines given by injection into a vein are fully absorbed and act quickly. This method is well
suited for relief of brief episodes of pain. When a patient controlled analegesia (PCA) pump is used, you
can control your own doses of pain medicine.
Risks: A small tube must be inserted in a vein. If PCA is used, there are extra costs for pumps, supplies,
and staff training. You must want to use the pump and learn how and when to give yourself doses of
medicine.
Injections into the spine
Medicine is given through a small tube in your back (called an epidural or intrathecal catheter).
Benefits: This method works well when you have chest surgery or an operation on the lower parts of your
body.
Risks: Staff must be specially trained to watch for problems that can appear hours after pain medicine is
given. Extra cost is involved for staff time and training and to purchase pumps and supplies.
NON-DRUG PAIN RELIEF METHODS
These methods can be effective for mild to moderate pain and to boost the pain-relief effects of drugs.
There are no side effects. These techniques are best learned before surgery.
Patient teaching
Learning about the operation and the pain expected afterwards (for example, when coughing or getting out
of bed or a chair).
Benefits: These techniques can reduce anxiety, they are simple to learn, and no equipment is needed.
Risks: There are no risks; however, patient attention and cooperation with staff are required.
Relaxation
Simple techniques, such as abdominal breathing and jaw relaxation, can help to increase your comfort after
surgery.
Benefits: Relaxation techniques are easy to learn, and they can help to reduce anxiety. After instruction,
you can use relaxation at any time. No equipment is needed..
Risks: There are no risks, but you will need instruction from your nurse or doctor. Physical agents
Cold packs, massage, rest, and TENS therapy are some of the non-drug pain relief methods that
might be used following surgery.
Benefits: In general, physical agents are safe and have no side effects. TENS, which stands for
transcutaneous electrical nerve stimulation, may be helpful; it is quick to act and can be controlled by the
patient.
Risks: There are no risks related to the use of physical techniques for managing pain. If TENS is used,
there is some cost and staff time involved for purchasing the medicine and instructing patients in its use.
Also, there is only limited evidence to support the effectiveness of TENS for pain relief in certain situations.
The information in this booklet was taken from the Clinical Practice Guideline for Acute Pain Management:
Operative or Medical Procedures and Trauma. The guideline was developed by a non-federal expert panel
made up of doctors, nurses, other health care providers, an ethicist, and a consumer representative. The
guideline, a development process, was sponsored by the Agency for Health Care Policy and Research
(AHCPR), an agency of the U.S. Public Health Service. Other guidelines on common health problems are
being developed and will be released in the near future.
For more information about the guidelines or other materials, call 1-800-358-9295, or write to the AHCPR
Publications Clearinghouse, PO Box 8547, Silver Springs, MD 20907.
U.S. Department of Health and Human Services Public Health Service Agency for health care policy and
research