Pain can be caused by surgical procedures, acute injuries or chronic conditions. Well-controlled pain speeds healing, leads to fewer complications and improves quality of life.
At The Christ Hospital Health Network, we understand how emotionally and physically draining pain can be for you and your loved ones. That’s why anesthesiologists, doctors specially trained in pain management, are a part of our medical teams.
Anesthesiologists use specialized techniques during surgery to keep you safe and comfortable. Too much pain medicine can cause sleepiness, nausea and vomiting; too little can limit your ability to breathe deeply, cough, walk and perform other necessary activities to speed recovery.
Talk about your pain
It’s important to talk to your doctor about your previous experiences with different pain control methods you’ve experienced, including:
Pain medications—If you have chronic pain, make a list of all the prescription and over-the-counter medications, plus supplements or herbs. Share this list with your doctors so they can determine any potential interactions with surgical or post-surgical pain medications. Be sure to mention what types of pain medicine worked, or didn’t work, for you.
Pain tolerance—This is the maximum amount of pain a person can bear. If you are experiencing any pain tolerance, talk with your doctors. Your body may be less sensitive to certain pain medications.
Drugs and alcohol—Tell your doctor if you're a recovering alcoholic or have a history of alcoholism or drug addiction so they can plan pain control that minimizes the risk of relapse. Withdrawing from these substances can be difficult and the post-surgical period is not the time to try it.
Ask questions—Be sure to ask any questions you may have about the type of pain medications you’ll receive, their side effects are and what can be done to minimize the side effects. Also, ask how severe the pain typically is following your type of surgery and how long it will last.
Discuss your concerns—If you're worried about side effects or overdosing on pain medicine, discuss this with your doctor. He or she can help you understand how to safely manage your pain, such as combining medications or using patient-controlled analgesia, which allows you to control your pain medication by pushing a button.
Be honest about your pain—Let your doctors and nurses know how much pain you’re in, where it hurts and what activities or positions make it better or worse. Your healthcare team will want to know the intensity of your pain on a 0 to 10 scale, where 0 is no pain and 10 is the worst pain you can imagine.
When your pain is under control, you can focus on the important work of healing. Work with your healthcare team to make your recovery as quick and pain-free as possible.
Types of pain control
The type of pain medication you receive depends on the kind of surgery you are having, the anesthesia used and your overall health.
Intravenous pain medication
Before surgery, a small plastic tube (catheter) inserted into a vein in your hand or arm is used to give you fluids, sedatives, anesthetics, antibiotics or pain medications. After surgery, this IV catheter may remain in place to deliver pain medication while you're in the hospital or outpatient recovery area. Pain relievers, such as opioids are usually injected into your IV catheter at regular intervals.
Most hospitals also offer patient-controlled analgesia (PCA) that allows you to give yourself a fixed dose of the medication by pushing a button. The PCA system has built-in safeguards to prevent you from overdosing on pain medication.
Pain medication is injected through a catheter inserted into the epidural space of your spinal canal. An epidural catheter is often used for labor and delivery and sometimes before an operation, such as a cesarean section or major abdominal surgery. The epidural catheter can be left in place for several days if needed to control postoperative pain.
A continuous infusion of pain relievers can be delivered through the catheter to control pain. Patient-controlled epidural analgesia (PCEA) lets you give yourself an extra dose of the pain medication by pushing a button. It has built-in safeguards so that you don't give yourself too much.
Some types of surgery can be done with spinal anesthesia. Unlike epidural analgesia, this form of pain relief involves medications injected directly into the spinal fluid. Spinal anesthesia is easier and faster than epidural analgesia is, but it doesn't last as long because there's no catheter for giving additional medication. Your doctor can add a long-acting medicine to the spinal medication that can relieve post-surgical pain for up to 24 hours.
A nerve block provides targeted pain relief to a specific area of your body and blocks pain messages from traveling up the nerve pathway to your brain. Nerve blocks are for outpatient procedures or complex inpatient surgery.
If you only need a few hours of pain relief, your doctor may inject local anesthetics directly into a wound or surgical cut, using a small needle. For longer pain relief, your anesthesiologist may place a catheter into that area to deliver a continuous infusion of pain medications.
Sometimes you may go home with a nerve block catheter attached to a pump that provides ongoing pain relief. Other procedures with radio-frequency ablation or cryoablation stop a nerve from working for a long period of time.
Oral pain medications
You'll probably change to oral medications in the hospital and continue taking them during your first few days or weeks at home. Examples include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)—Traditional NSAIDs, such as ibuprofen (Advil, Motrin IB, others), reduce swelling, soreness and minor pain. They may be used after minor procedures or combined with other medications for treatment after major surgery or during home recovery. Combining NSAIDs with opioids gives maximum pain relief, but with fewer side effects.
Opioid pain relievers—The same or similar medications that are used in an IV catheter or PCA are available in oral form (pills). Oral opioids work well on severe pain, but the relief can come with side effects, including drowsiness, nausea and constipation. Many oral opioids are combined with acetaminophen (Tylenol, others), so be careful not to take too much acetaminophen, which is found in many over-the-counter pain relievers, cold medicines and sleep aids.
Multimodal pain relief— This involves receiving a combination of opioid and one or more other drugs, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others), celecoxib (Celebrex), ketamine (Ketalar) or gabapentin (Gralise, Neurontin). All of these medications can relieve pain and each can be given in low enough doses to avoid side effects. The additional drugs are usually taken in tablet form. The combination may improve pain relief and reduce side effects by reducing the need for opioids.
Non-medicated pain management
Your doctor also may recommend other methods of pain management, such as rest, ice and elevation. You can also use these non-medication methods to help control your pain:
Relaxation tapes or guided imagery is a proven form of focused relaxation that coaches you in creating calm, peaceful images in your mind—a "mental escape." For best results, practice using this technique before your surgery, and then do it twice daily during your recovery.
Listen to soft music, change your position in bed or tune in to your internal music channel to relieve or lessen pain.
Use heat or cold therapy to help reduce swelling and control pain. Discuss specific instructions for these therapies with your doctor.
If you have an abdominal or chest incision, splint the area with a pillow when you cough or breathe deeply to decrease motion near your incision. Do this in the hospital and at home.