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Pain management—understanding acute pain

Recent studies indicate that prolonged severe pain can affect many systems in the body causing reduced physical and emotional well being. Therefore, controlling your pain after surgery is an important part of your recovery. Every effort will be made to keep you comfortable so that you are able to resume activity which is important for your emotional and physical well being.

How to manage pain

Discuss the amount of pain you may expect and options for pain management with your doctors, nurses and physiotherapist before your operation. Speak to your anaesthetist about pain control before your operation. Anaesthetists are responsible for the more complex methods of pain management, such as epidurals.

It is also important that you tell your doctor and anesthetist if you are normally on medication for pain prior to your surgery. They will need to know the name, dose and the how often you take the medication. This will help them manage your pain more effectively after surgery.

Don’t wait to be asked!

Taking an active approach to your pain management, in partnership with your health care team, will ensure excellence in your care post-operatively. In order to reduce discomfort and help healing, several options for pain management are available and sometimes different methods of providing pain relief are offered at the same time. If your method of pain relief is not effective, let your nurse know and don’t suffer in silence. Remember, you are the only person who really knows about your pain and what works for you. Therefore, we encourage you to speak up before the pain gets too severe because pain is harder to treat if it is out of control. It may not always be possible to completely stop pain or discomfort but it can usually be improved.

Assessing your pain

One method for assessing pain is a self rating pain scale using a number between zero and 10 to best describe your pain. After your surgery you will be frequently asked to score your pain in this way. Below is an example of how this rating scale can be used.

1

Some people are unable to describe their pain according to the above scale so it might be easier for you to use other terms such as mild, moderate or severe. Regardless of how you describe your pain it is important that you are able to take deep breaths, do your physiotherapy and move comfortably after your surgery. The pain rating you give us needs to be based on your ability to do this.

Treating your pain

Mild to moderate pain

Simple analgesics such as paracetamol (Panadol, Panamax) and anti-inflammatory drugs (Nurofen, Indocid, Voltaren) will be used to treat your pain while you are in hospital if you are able to tolerate them. These will often be prescribed together and given on a regular basis as regular doses of this combination works well for mild to moderate pain.

Severe pain

For more severe pain, stronger pain relieving medication will be given in addition to the above. This might include Morphine, Fentanyl or Oxycodone. This group of medication is called opioids. If you require an opioid, your anaesthetist or surgeon will discuss with you the most appropriate way of administering this to you.

Opioids may be given in several different ways, including by:

  • mouth
  • rectally (suppository)
  • injection into the muscle or under the skin
  • intravenous injection or drip
  • epidural or spinal injection.

One of the intravenous (IV or drip) methods of opioid delivery is called Patient Controlled Analgesia (PCA). This involves a computerised pump which attaches to a drip in your arm and allows you to administer your own pain medication as you require. The anaesthetist will discuss PCA with you and explain it to you if it is appropriate for you to use.

Epidural pain relief may also be an option after some operations. This will also be explained and discussed with you by your anaesthetist.

The Acute Pain Service

If you have an epidural or PCA the Acute Pain Service (APS) will visit you on a daily basis. They will discuss with you how effective your pain relief is and when you are able to resume eating and drinking they will change your pain medication to oral tablets. The nurse looking after you will also regularly assess your pain and will vary your pain management within the guidelines set by your doctor or the APS. If your pain is not relieved, please let the nurse looking after you know and they will contact your doctor or APS for further instructions.

What about opioid related side effects?

The aim of good pain control is pain relief without unpleasant side effects. All drugs have side effects which affect some people. Close observation and monitoring is performed by nursing staff to ensure any side effects are managed promptly. You will still be closely monitored during the night, and you may be woken if nursing staff have any concerns.

Some side effects of opioid medications include:

  • drowsiness
  • respiratory depression
  • nausea and vomiting
  • vivid dreams
  • itching
  • constipation (if opioids are used for more than
    a few days).

It is important that you report any side effects you may be experiencing to the nursing staff so that they can be treated before they become too severe.

Usually any side effects can be controlled by:

  • reducing the amount of the drug you are taking
  • giving another drug to stop the side effects
  • changing to another pain relieving medications.

Please remember that these are side effects and do not necessarily mean you are allergic to the medication.

2Addiction

Some people worry about the risk of becoming addicted if they use strong pain medication (e.g. opioids). The risk of this occurring when being used for pain relief after an operation is extremely rare, therefore we encourage you to use the pain medication. If you have any concerns about addiction please speak to your nurse, doctor or pharmacist.

 

© 2012 Mater Misericordiae Ltd. ACN 096 708 922

Mater acknowledges consumer consultation in the development of this patient information.
Last modified 09/11/2015.
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