Most people think of pain from surgery as something you deal with after the operation, but there are things you can do beforehand to decrease your discomfort and manage your pain. Researchers have found better ways to control pain before surgery, at the hospital and when you come home to recuperate. Many people have an operation at some point in their lives, so it can help to know what you can do about pain before and after surgery.
The “old school” way of managing pain after surgery was to drug up the patient on heavy duty painkillers, like opioids, for days or weeks after surgery until the body healed itself enough to no longer hurt very much. With the prescription painkiller addiction problem and related heroin epidemic in the United States, researchers have been searching for better options that also do not carry the opioid side effects of nausea, constipation and dizziness.
Benefits of Avoiding or Minimizing Opioids
You can relieve pain, decrease your risk of gastrointestinal and respiratory complications and spend less time in the hospital by using three other (non-opioid) drugs together with limited use of opioids, as compared to using the traditional doses of opioids and not using the three other medications. Researchers found that people who did not take opioids at all before, during, or after surgery, were released home faster than those who did use the strong painkillers. (Some people take painkillers before joint replacement surgery to manage the pain in the joint that has failed.)
Researchers focused on 1.5 million patients undergoing joint replacement surgery, like knee or hip replacement. Caveat: the people who took fewer painkillers might have experienced better outcomes because of other factors, like their age, overall health before surgery and less severe joint problems.
General Anesthesia and Opioids
You can reduce your post-op pain levels and thereby, your need for opioids, if you opt for a local anesthetic instead of general anesthesia. General anesthesia knocks you out for the procedure, working systemically. Local anesthesia combined with a peripheral nerve block, on the other hand, works by blocking the pain receptors at and near the incision.
The doctor will inject a numbing agent near a particular nerve or bundle of nerves. The nerve block can provide pain relief after the procedure, lowering your need for painkillers.
The Non-Opioid Pain Prevention Cocktail
The Cleveland Clinic performed a study in which it gave patients a combination of three drugs before surgery to prevent the central nervous system from creating massive amounts of pain-creating chemicals, as a response to the operation. The three medications were acetaminophen (Tylenol), gabapentin (a nerve pain drug) and the NSAID pain reliever celecoxib (Celebrex). None of the three medications is an opioid.
Some doctors also gave the patient a steroid before surgery. The theory was that the steroid suppresses the human body’s fight or flight response, when waking up from surgery. The fight or flight response can increase a person’s pain.
After Surgery
You can take control of post-surgical pain with little if any need for opioids. Have your doctor put together a schedule for you to take alternating doses of over-the-counter meds like acetaminophen and NSAIDs for mild to moderate discomfort. Nerve pain drugs like gabapentin (Neurontin) or pregabalin (Lyrica) can help reduce post-op pain that the over-the-counter remedies do not control.
The quicker you get back up on your feet after surgery, the better your recuperation is likely to be. Being active within the parameters of your doctor’s instructions can reduce inflammation and prevent GI or respiratory complications. Physical therapy can be uncomfortable in the moment, but skipping PT can slow your recovery, increase your pain and cause a less-than-optimal outcome with decreased strength, mobility and range of motion.
References:
AARP. “Managing Pain Before and After Surgery.” (accessed May 15, 2019) https://www.aarp.org/health/conditions-treatments/info-2019/pain-after-surgery.html
