Pain Control After Surgery

From the Agency for
Healthcare Research and Quality

What is pain?

Pain is an uncomfortable feeling that
tells you something may be wrong in your body. Pain is your body’s way
of sending a warning to your brain. Your spinal cord and nerves provide
the pathway for messages to travel to and from your brain and the other
parts of your body.

Receptor nerve cells in and beneath
your skin sense heat, cold, light, touch, pressure, and pain. You have
thousands of these receptor cells, most sense pain and the fewest sense
cold. When there is an injury to your body–in this case surgery–these
tiny cells send messages along nerves into your spinal cord and then up
to your brain. Pain medicine blocks these messages or reduces their
effect on your brain.

Sometimes pain may be just a nuisance,
like a mild headache. At other times, such as after an operation, pain
that doesn’t go away- -even after you take pain medicine–may be a
signal that there is a problem. After your operation, your nurses and
doctors will ask you about your pain because they want you to be
comfortable, but also because they want to know if something is wrong.
Be sure to tell your doctors and nurses when you have 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

  • 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. You may even leave the hospital sooner.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

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–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–even those who have
had the same operation.

Before surgery

Drug treatment:

Take pain medicine.

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:

Receive general anesthesia, spinal
anesthesia, or nerve blocks, or take a pain medicine through a small
tube in your back (called an epidural).

After surgery

Drug treatment:

Take a pain medicine as a pill, shot,
or suppository, or through a tube in your vein or back.

Non-drug treatment:

Use massage, hot or cold packs,
relaxation, music or other pastimes to 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.

  • Will there be much pain after
    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
with your doctors and nurses.

Be sure to:

  • 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, the 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.

  • 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


For both ways, your nurses and doctors
will ask you how the pain medicine is working and change the medicine,
its dose, or its timing if you are still having pain.

4. Work with your
doctors and nurses to make a pain control plan.

You can use the form at the end of this
article to begin planning for pain control with your nurses and doctors.
They need your help to design the best plan for you. When your pain
control plan is complete, use the form to write down what will happen.
Refer to it after your operation. Then keep it as a record if you need
surgery in the future.

After surgery

5. Take (or ask for)
pain relief drugs when pain first begins.

  • Take action as soon as the pain
    If you know your pain will worsen
    when you start walking or doing breathing exercises, take pain
    medicine 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.

  • They may 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 2 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.
    They may ask you to use a “pain
    scale” like the one shown on below.


7. Tell the doctor or
nurse about any pain that won’t go away.

  • Don’t worry about being a
    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.

Rhythmic Breathing for Relaxation

  1. Breathe in slowly and
    As 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

  2. 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

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.

Pain Intensity Scale

0-10 Numeric Pain Intensity Scale ________________________________________________ | | | | | | | | | | | 0 1 2 3 4 5 6 7 8 9 10 No Moderate Worst pain pain pain

Benefits and Risks of
Pain Treatment Methods [Section not in Published Version]

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

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.


There is no risk of addiction to these
medicines. Depending on how much pain you have, these medicines can
lessen or eliminate the need for stronger medicines (for example,
morphine or another opioid).


Most NSAIDs interfere with blood
clotting. They may cause nausea, stomach bleeding, or kidney problems.
For severe pain, an opioid usually must be added.


Morphine, codeine, and other opioids
are most often used for acute pain, such as short-term pain after


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.


Opioids may cause drowsiness, nausea,

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.


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.


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).


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.


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


Medicine given by injection into skin
or muscle is effective even if you are nauseated or vomiting; such
injections are simple to give.


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 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.


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 analgesia (PCA)
pump is used, you can control your own doses of pain medicine.


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

Medicine is given through a small tube
in your back (called an epidural or intrathecal catheter).


This method works well when you have
chest surgery or an operation on the lower parts of your body.


Staff must be specially trained to
place a small tube in the back and 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

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).


These techniques can reduce anxiety;
they are simple to learn, and no equipment is needed.


There are no risks; however, patient
attention and cooperation with staff are required.


Simple techniques, such as abdominal
breathing and jaw relaxation, can help to increase your comfort after


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.


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.


In general, physical agents are safe
and have no side effects. TENS, which stands for transcutaneous
electrical nerve stimulation, is often helpful; it is quick to act and
can be controlled by the patient.


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 machine and instructing
patients in its use. Also, there is only limited evidence to support the
effectiveness of TENS for pain relief in certain situations.

Pain Control Plan

Pain control plan for
Your name

Before surgery, I will take
Name of medicine

How I will use the medicine

After surgery, I will
take________________________________________in the hospital.
Name of medicine

The medicine will be given to
__________as a pill__________through a vein
__________as a shot _________through a tube in my back.

I will receive the medicine:
__________at certain times
__________every__________hours for_________days:
__________around the clock
__________when I call the nurse.

I will also use these non-drug
pain control methods in the hospital and at home (list methods):

At home, I will take
Name of medicine

How I will use the medicine at