We Care About You: Managing Post-Operative Pain

Scripps is committed to always caring for our patients before, during and after surgery. This handout provides important information about management and treatment of post-operative pain that will aid in your successful recovery and help you return to your normal level of functioning as soon as possible. If you have questions at any time, please contact your doctor’s office.

 

Some pain is acceptable.

The first thing to know is that having some pain is normal and should be expected after most surgical procedures. In fact, doctors now think that accepting some pain is a good thing, for a few reasons: 1) Adapting to mild or moderate pain means you can use less medication, and using less medication (especially opioids, also known as narcotics), helps you avoid harmful side effects that can slow down your recovery, such as constipation or feeling woozy; 2) Pain tells your body how much activity you can do as you recover; and 3) Taking fewer opioids lowers your risk of becoming dependent on them.

 

Multi-modal pain management

The best way to manage acute pain is through multi-modal pain management, which means using many different methods to minimize your pain. Using a combination of non-opioid (non-narcotic) medications and drug-free pain relief techniques often works better than a single medication, and will help you recover as quickly and safely as possible while also reducing your exposure to opioid medication. The goal of multi-modal pain management is to use the least amount of opioids possible and stop using them as quickly as possible to avoid the risks of side effects and addiction.

 

Drug-free techniques to reduce pain

Be sure to check with your doctor before undertaking any of the techniques described below.

• Resuming gentle activity (including physical therapy)

• Ice (cryotherapy)

• Deep breathing (for some conditions, you will use a device called an incentive spirometer to help you

  take deep breaths and keep your lungs healthy)

• Meditation or hypnosis

• Massage or healing touch

• Guided stretching (e.g., yoga)

• Distraction (watching a movie, talking to friends, playing computer games)

 

Non-opioid medications your doctor may prescribe:

• Acetaminophen (Tylenol, APAP): the most gentle and safe pain medication you can take.

• Anti-inflammatory medication (NSAIDs): ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib

  (Celebrex  and others. These medications can be taken along with Tylenol, but you may not be able to

  take NSAIDs if you have stomach ulcers or kidney disease.

• Gabapentin (Neurontin) and pregabalin (Lyrica): used for nerve pain or neuropathic pain.

• Lidocaine patch or cream: applied to your skin. It can be prescribed or obtained over the counter.

 

Opioids (narcotics) your doctor may prescribe

If you have a very painful condition, you doctor may prescribe an opioid for a brief time. Opioids are very strong pain medications. They can have serious and unpleasant side effects, including addiction. Opioids include:

• Morphine

• Dilaudid

• Oxycodone (Percocet)

• Hydrocodone (Norco)

 

 

Side effects of opioids

• Constipation

• Feeling woozy or confused

• Hallucinations

• Nausea or vomiting

• Increased risk of falls and accidents

• Breathing problems

• Addiction

 

Five to 10 percent of people who take opioids for more than a few days will become dependent on them. The risk of addiction can increase after as little as three days of use, and people who become dependent often go through withdrawal when they stop taking an opioid medication. Withdrawal symptoms can be very unpleasant, and include:

• Body aches

• Nausea or vomiting

• Diarrhea

• Insomnia

• Restlessness

 

Tell your doctor right away if you think you are having trouble stopping opioid use or if you experience withdrawal symptoms.

 

If you are prescribed an opioid

• Remember that the goal is to get you back to your normal level of functioning, not to take away all your pain.

• Make the most of all your other pain management options (ice, activity, other medications) before you

  take an opioid.

• Ask your doctor how long you are expected to need an opioid. Have a goal for when you want to stop

  using it.

• Your doctor may give you an option of one or two tablets per dose. Start with the lower dose and see if

  that works before taking the higher dose.

• We advise most patients to stop opioids within three days. However, if your pain is severe and

  expected to continue for some time, you may be given a longer course of opioids.

• Try to take the opioids less frequently each day. It is better to taper off gradually than to stop suddenly.

• Ask your doctor if you would like a tapering schedule. This is a good idea if your doctor expects you to

  need opioids longer than three days.

• Tell your medical team if you have side effects, like nausea or constipation—they can help you.

 

Proper disposal of opioid medication

Many patients do not use all the opioids that are prescribed to them. Leftover medications sitting in a medicine cabinet can end up being misused by someone else, such as a child, a guest or someone working in your home. Please store your medications in a safe place where no one else has access to them. Federal (FDA) guidelines recommend flushing any leftover opioids down the toilet, but San Diego County prefers that you throw them away mixed with compost, coffee grounds or kitty litter, or take them to an approved disposal site.