You've just had major surgery, and with it can come pain that is tough to tame.
Since post-surgical pain management may help make your recovery go more smoothly, a doctor talks about the different post-surgical pain treatment options, how they work and what kind of pain they help to treat.
Pain after surgery: What to expect
According to U.S. National Library of Medicine, your type of surgery, pain tolerance and surgery length can all affect how much post-surgical pain you feel and for how long. Pain control after your surgery is important because it can:
Reduce your risk of developing blood clots
Reduce the length of your hospital stay
Lower your risk of developing chronic pain
After surgery, your pain medicine may be delivered in a number of ways, including via IV, shots, pills or an epidural.
Postoperative pain management options
Opioids
“There's short-acting opioids and there's long-acting opioids,” explained Dr. David Hiller, an interventional pain specialist with Scripps Clinic in San Diego. “So typically, a surgeon for just what we call nociceptive postoperative pain would give a small amount of short-acting opioids, something like hydrocodone or oxycodone, no more than about a seven-day supply.”
The American Society of Anesthesiologists (ASA) says that opioids work by attaching to their namesake receptors to stop pain responses.
“The goal is to treat their pain, to honor their pain, but to obviously not have patients become reliant or stay on opioid medications for any longer than they have to,” Hiller said.
Non-opioid pain medication
Hiller explained that because of the opioid epidemic, Scripps Health created an Opioid Stewardship Program (OSP) aimed at moving patients away from opioid pain medication to reduce their risk of drug dependency and overdose.
According to pharmacist Angela Rosenblatt, co-chair of the Scripps OSP, between 2019 and 2022 high-dose opioid prescriptions were reduced by 25% upon discharge from their hospitals.
Here are the main types of non-opioid pain medications that are prescribed after surgery, according to Hiller.
Acetaminophen
“There are lots of studies that show that using acetaminophen… actually reduces the need for opioids quite a bit. There are things you can do intraoperatively sort of towards the end of surgery, like IV Tylenol, and that actually has a profound effect [on reducing pain],” Hiller said.
The Society of Hospital Medicine (SHM) notes that acetaminophen works by inhibiting certain hormonal-like actions in the central nervous system to help alleviate pain. It can be used for different levels of pain, either right after surgery or when recovering at home.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Because acetaminophen doesn’t work on reducing inflammation in the nerves that branch out throughout the body, the SHM says that a group of medications called NSAIDs may be prescribed to reduce pain and inflammation in these areas.
NSAIDs, like aspirin, are often given for certain short-term post-surgical pain. Hiller said that they can be used in combination with other medications to help optimize non-opioid post-surgical pain management.
Ketamine
If a patient has either a tolerance or an intolerance to opioids, ketamine is a potent drug that may be given immediately after surgery, according to StatPearls.
“Ketamine infusions [are used] for people where you anticipate a high opioid need, [and] that can certainly reduce it,” Hiller said.
A review published in the Expert Review of Clinical Pharmacology says that ketamine may provide pain relief in a few ways, including by blocking receptors of a pain-signaling agent called glutamate.
Other non-opioids
Hiller and the SHM advised that the following non-opioid medications may also be used after surgery:
Nerve stabilizers such as gabapentin or pregabalin to help with neuropathic (nerve) pain
Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine to help with musculoskeletal and nerve pain
Local and regional anesthesia
“We do lots of regional blocks or joint injections or spine injections to reduce inflammation around a particular nerve using image guidance both preoperatively and postoperatively, or to reduce inflammation in a joint space,” said Hiller. “And that's typically with local anesthetic and a corticosteroid.”
Constipation-relief medication
“Certainly, opioids are notorious to cause opioid-induced constipation, and that can become a problem,” Hiller explained.
He said that to treat the issue, a stool softener like docusate or a medication called methylnaltrexone (which works on opioid receptors in the bowel) is given to patients.
Medication for side effects
“There are multiple medications out there to treat opioid-induced side effects and typical surgical side effects [such as] nausea and vomiting. There’s antiemetics like Zofran. Even dexamethasone…can help with that,” Hiller explained.
Multimodal postoperative pain management
As you move out of surgery into recovery, there are several strategies Hiller recommended that may help increase your naturally occurring opioids, including:
“All of these things actually increase your natural opioid analogs. So those are your body's natural ability to fight pain,” Hiller noted.
References
David Hiller, MD, interventional pain specialist, Scripps Clinic, San Diego
The Society of Hospital Medicine: Multimodal Pain Strategies Guide for Postoperative Pain Management
Medline Plus: Post-surgical pain treatment in adults
Scripps Health: Scripps Health Launches Opioid Stewardship Program
American Society of Anesthesiologists: What Are Opioids?
StatPearls: Postoperative Pain Control
Expert Review of Clinical Pharmacology: Emerging concepts on the use of ketamine for chronic pain
Frontiers in Molecular Neuroscience: Emerging trends in pain modulation by metabotropic glutamate receptors
Drugs.com: venlafaxine
Drugs.com: duloxetine
