Pain Management

Comfort Goal

The nurse will help you set an appropriate comfort goal and explain the pain rating scale. Reporting your pain as a number helps the health care team assess and treat your pain. You'll be asked to rate your pain on a scale of one to 10, with “one” being minimal pain and “10” being the worst pain you can imagine.

It's not realistic to set a comfort goal of zero (no pain) after a surgical procedure. You will have some discomfort even after minor procedures. Your doctors and nurses want, and need to know, about any pain that isn't under control. Our goal is to help you manage your pain so you can participate in all the activities of your recovery, such as deep breathing, coughing, walking or sitting in a chair.

Types of pain

Sometimes pain is felt in other areas after surgery in addition to the incision. You may feel discomfort in these areas: 

  • Muscle aches and pain in the back, shoulders or chest from lying on the operating table
  • Sore or scratchy throat from the breathing tube placed during surgery
  • Pain at the incision site when you move about, such as sitting up, coughing and walking
  • If you had a laparoscopic procedure, you may experience referred pain in your upper back or shoulder from air pushing against the diaphragm.  

Pain control and management

Appropriate pain management is important in the healing and recovery process. Opioid medicine may be appropriate in the immediate period after surgery when your pain is severe. However, it is important to understand that opioid medicine has some risks and should be used only as directed by your doctor. It is much easier to manage pain if you take pain medicine before it gets severe.  

Your doctor will prescribe pain medicine that is appropriate for you. Every person is unique and your doctor will use pain medicine that is individualized for your needs. It is important to work with your health care providers so your pain can be managed effectively. It may be dangerous to get rid of all of your pain, but if your pain is managed well, you will be able to do the things you need to do for a safe recovery.  

While pain medicines have some addiction risks, adequately managing pain after surgery is important for healing. Pain medicine should be taken during your recovery as directed by your health care provider. After your recovery is complete, pain medications should be disposed of properly. 

There are many other ways to manage pain without taking medicine. Some of these measures include:

  • Splinting the area of the body that hurts
  • Re-positioning
  • Using ice packs 
  • Relaxation breathing
  • Meditation
  • Listening to music
  • Dimming lights
  • Distraction
  • Keeping noise levels low
  • Talking with a chaplain

Medications

Patient-controlled intravenous analgesia (PCA)

PCA is a system that allows you to administer your own pain medication immediately by pressing a button. Advantages include:

  • no painful injections
  • no delay in getting your medication
  • immediate and more consistent pain relief
  • tendency to use less pain medication than those who receive pain shots
Pain medication dose and frequency is set by your physician. If you push the button too soon, you will not receive the medication.

Epidural infusions

Many people are familiar with epidural anesthesia because it's frequently used during childbirth. A post-operative epidural may be considered for some surgeries. Some patients aren't candidates for epidurals because of specific underlying illnesses or medications. Epidurals usually offer superior pain relief and don't normally cause sedation or drowsiness. Epidurals may be placed using local anesthesia while you're awake or during surgery while you're asleep. The anesthesiologist places a very tiny catheter into the epidural space in your back. Medications are given through this catheter, which is secured with tape. You may lie on the catheter without disturbing it or experiencing discomfort.

Nerve blocks

Pain relief may be provided by a nerve block. A long-acting anesthetic is injected into a specific area, which keeps the area numb for several hours after surgery. This block significantly reduces the amount of pain medication needed. In some cases, a nerve block may be used for the anesthesia for the surgery, but you'll also be given medications during your surgery to keep you sleepy. In some instances a tiny catheter may remain to provide a continuous block. If you receive a continuous block, you'll need help to get up. If you go home before the catheter is removed, education will be provided. Examples of blocks include spinal, bier block and peripheral nerve blocks.

Oral pain medications

Most oral medications can be taken every three to four hours. Request your pain medication when you're beginning to feel uncomfortable - don't wait until your pain is severe. If you'll require pain medication at home, you'll be given a prescription for pain medication before you leave the hospital. The hospital does not fill outpatient prescriptions. Planning ahead to have your prescription filled after you leave the hospital is an important part of your home care.

Post-op Exercises & Activity

Postoperative exercises are extremely important. Activity stimulates circulation and deep breathing speeds recovery. Don't wait to be prompted - ask your caregiver if you can begin activity. Remember that you're part of your health care team.

Ask for help if you need to move around. Some exercises you can do on your own, such as deep breathing and coughing. 

For your lungs

Deep breathing and coughing help prevent pneumonia after surgery. Take a slow, deep breath and hold it for a second or two, then push the air our of your lungs with a deep, strong cough. For abdominal or chest surgeries, place a pillow over your incision and apply gentle pressure to this area as you cough. This helps support your incision and lessens your discomfort. You may be asked to use an incentive spirometer. This is a small plastic device that encourages you to breathe effectively. Your preadmission nurse will teach you how to use the spirometer, if needed.

For your circulation

Walking will help you recover faster and return to normal. Be sure to have help the first few times you get out of bed and begin walking. Don't overdo it. Gradually increase your activity. 

Turn from side-to-side or side-to-back, unless this is not allowed with your surgery. Change positions every one to two hours - it helps your lungs and your circulation when you move around. 

Your risk of forming a blood clot increases whenever the movement of blood is sluggish or if the blood vessel is diseased or damaged. To help prevent this from occurring, do these exercises every one to two hours when you are awake:

  • Push your toes toward the foot of the bed. Relax both feet. Pull your toes toward your chin. Relax both feet.
  • Make circles with both ankles. Bend each knee alternately, sliding your foot up along the bed. Relax.

Your doctor may order sequential compression devices (SCDS) with plastic sleeves that fit around your legs and a motor that attaches to the sleeves with tubing. This motor inflates and deflates the sleeves, which increases the blood flow in your legs.

Foot pumps are a sleeve that fits around your foot. Similar to SCDS, this device has a motor that attaches to the sleeves with tubing. This motor inflates and deflates the sleeve which increases your blood flow. The sleeves can be removed when you walk, bathe or leave your room for tests. It is important to reapply the sleeves when you return to bed.

Relaxation Techniques

Relaxation breathing

Breathe in slowly and deeply. As you breathe out slowly, feel yourself begin to relax and let the tension leave your body. Focus on breathing.

Mental imaging

Close your eyes and imagine a peaceful and comfortable place. Use this while breathing deeply and thinking peaceful and relaxing thoughts. 

Positioning

Change your position when you become uncomfortable. Use pillows to support your arms, legs and back. 

Music

Listen to your favorite music.

Surroundings

Keep the lights and noise in your room as low as possible. 

Healing Touch

This is a gentle, non-invasive, complementary approach to health and healing. Healing touch can reduce pain, relieve symptoms during or after chemotherapy, decrease depression, anxiety, stress and support withdrawal from substance abuse. If you are interested in Healing Touch, let your nurse or doctor know. Trained staff can provide the service for a reasonable rate.

Massage therapy

Massage has many proven physical and mental benefits including reduction of pain, stress relief, reduction of muscle spasms and relaxation. All of these factors aid in the healing process. If you are an outpatient, call 269-3282 for massage services provided by CoxHealth Fitness Centers. Inpatients should speak to their nurse or physician to order massage therapy. Please note that most insurance companies do not cover massage therapy, but the service is available at a reasonable rate. Financial assistance for inpatient massage therapy services is available for those who qualify.

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