Post-Surgical Pain

What is post-surgical pain?

Pain that occurs after surgery is an important concern. Before your surgery, you and your surgeon may have discussed how much pain you should expect and how it will be managed.

What are the causes?

The cutting of the skin stimulates nerve fibers to signal pain. As the body begins to heal, pain should decrease and eventually stop. The amount of time pain lasts after surgery can depend on several factors such as the following:

  • A person’s general health
  • The presence of coexisting medical problems
  • Cigarette smoking

On rare occasions, pain may remain, though the cause of pain cannot be identified. This condition can become long-term pain.

Pain after surgery can be a sign of surgical complications such as the following:

  • Infection either in the skin or at another site in the body: Pain with fever (temperature higher than 100°F) or pain with redness, pus, or swelling at the surgical site is often a sign of infection.
  • A break in the wound or separation of the wound edges prior to healing (called dehiscence): If the stitches or staples in the surgical wound are not holding the skin together, a dehiscence may be present.
  • A collection of blood or other body fluid below the skin (a hematoma or a seroma): This collection of blood or fluid may cause pain and sometimes swelling at the wound site. This collection may have to be drained by a doctor.
  • Vomiting or a change in your bowel habits after abdominal surgery: An obstruction in normal bowel functioning can occur following abdominal surgery and often causes pain and vomiting. Similarly, loss of intestinal movement (called ileus) may cause pain, abdominal distention, and vomiting. Both of these conditions need to be checked by a doctor.
  • Formation of fistulas (abnormal passages between body structures): For example, a fistula may form between the bowel and the skin. Pain may be present with fistulas, but often only drainage from the surgical site, change in bowel habits, or weight loss may be present. Leaks occur when 2 pieces of bowel have been surgically connected and the connection fails. Bowel contents will leak out into the abdomen and may cause pain, vomiting, or fever.
  • Lung complications: Especially after long surgeries or surgeries that require long recovery periods, a lung complication may occur. These complications may include pneumonia or a blood clot to the lung, called a pulmonary embolus, which may cause a cough, chest pain with breathing, fever, or shortness of breath.
  • Chest pain: Have a doctor check any chest pain after surgery. People with prior heart problems are particularly at risk for heart attack (myocardial infarction) or partial blockage of the coronary blood vessels (unstable angina).
  • Bleeding, either from the wound (external) or into the body (internal): Bleeding complications can range from minor problems to major life-threatening emergencies.
  • Chronic conditions: If you have a chronic medical condition that causes pain, such as lupus or rheumatoid arthritis, you may find that surgery makes these conditions worse. Talk to the doctor before and after a surgical procedure to try to minimize the risk of making these conditions worse.

What are the symptoms?

Pain may be described in many ways. You may be asked to identify the following qualities of the pain:

  • Character – The type of pain, stabbing, sharp, dull
  • Location – Where the pain is
  • Duration – How long your pain lasts
  • Severity – On a scale from 1 to 10, with 10 as the worst pain you have ever experienced
  • Radiation – Movement from one location to another
  • Movement of pain location
  • Things or movements that make pain better or worse

In addition to pain, tell the doctor about other associated symptoms such as the following:

  • Fever (temperature higher than 100°F [38 ºC])
  • Nausea, vomiting, or both
  • Constipation
  • Diarrhea
  • Pus or discharge from the wound
  • Redness or swelling
  • Shortness of breath

What are the treatments?

Several factors determine how much pain you have and how to manage it:

  • Different types of surgeries and surgical cuts (incisions) cause different types and amounts of pain afterward.
  • A longer and more invasive surgery, besides causing more pain, can take more out of you. Recovering from these other effects of surgery can make it harder to deal with the pain.
  • Each person feels and reacts to pain differently.

Controlling your pain is important for your recovery. Good pain control is needed so you can get up and begin to move around. This is important because:

  • It lowers your risk of blood clots in your legs or lungs, as well as lung and urinary infections.
  • You will have a shorter hospital stay so that you go home sooner, where you are likely to recover more quickly.
  • You are less likely to have lingering chronic pain problems.

Your Role in Controlling the Pain

There are many types of pain medicines. Depending on the surgery and your overall health, you may receive a single medicine or a combination of medicines.

Studies show that people who use pain medicine after surgery to control pain often use fewer pain medicines than those who try to avoid pain medicine.
Your job as a patient is to tell your health care providers when you are having pain and if the medicines you are receiving control your pain. Providers will always be busy, but do not worry about bothering them. Speak up. In the end, you are the one in control of your pain.

Advanced Pain Institute

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