Not All Pain Is Gain: Managing Pain After Surgery

For centuries, people have always thought that what doesn’t kill you makes you stronger, meaning that some pain can be good for us. Our society often celebrates people who can bear high levels of pain as we view them as stoic and brave. However, many doctors suggest that this is not necessarily true. They advise that especially after surgery, managing the pain is crucial for patient recovery and long-term health.

Pain is an uncomfortable sensation that is triggered by the nervous system. There are two types of pain: acute and chronic. Acute pain occurs over a short period of time and is generally caused by an injury. Chronic pain can persist over days or weeks, and can be due to a medical condition such as arthritis or cancer. It is estimated that around 76 million Americans suffer from chronic pain, which is higher than the number of cancer, diabetes, stroke and heart disease patients combined.

Pain is subjective and thus very hard to measure, as there are no physiological tests or imaging devices that can accurately assess a patient’s level of pain. Instead, doctors have to rely on the patient’s perception of the severity of pain, typically measured on a 1 to 10 pain scale. The scale, commonly used in hospitals, starts with zero, which means no pain at all and is visually represented by a smiley face. At the other extreme is a full-blown tearful frown corresponding to a ten, which is severe pain.

Ten years ago, the Joint Commission, the organization that accredits hospitals in the US, put in place some new standards on how hospitals should handle pain management. The standards require hospitals to

• recognize patients’ rights to appropriate assessment and management of pain
• assess pain in all patients
• educate patients, families, and providers
• establish policies that support appropriate prescription or ordering of pain medicines
• include patient needs for symptom control when planning discharge from the hospital

Pain relief medicines include nonsteroidal anti-inflammatory drugs such as acetaminophen, aspirin or ibuprofen; opioids such as morphine and codeine; and local anesthetics such as bupivacaine.

After surgery, good pain management allows patients to start moving faster, which in turn helps them breathe better. Quick movement can prevent blood clots in legs, while improved breathing can prevent pneumonia. Moreover, better management of acute pain after surgery prevents nervous system inflammations which can cause chronic pain in some patients.

Prior to surgery, patients need to sit down with the doctors and nurses to discuss how they can keep their pain under control. For example, they might want to ask about what to expect: will there be much pain after surgery? Where will it occur? And how long is it likely to last? Also, patients should discuss what pain control methods they prefer and the concerns that they might have. After surgery, a pain management plan is developed for every patient. For example, instead of waiting until pain breaks through, the patient can get medications at set times during the day to keep the pain under control.

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