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Treatment of Pain After Operation

Posted on November 17, 2021 | 1 Comment on Treatment of Pain After Operation

Mr. Reyes is a 41-year old father of three who has had diabetes since 10 years ago. He is scheduled for a cholecystectomy, an operation to remove his gallbladder. He is feeling very nervous about the upcoming operation. In particular, he says that: “I am afraid that I will be in a lot of pain after I wake up from the operation.” After talking with Mr. Reyes, his doctor notes that he has a lot of questions and worries.
• What is pain? Does it help me in any way?
• What can be done to control my pain after my operation?
• How will my doctor know how much pain I have?
• What can I do to make sure that I will not have pain after my operation?

These are very typical concerns for someone who is about to get an operation. Let us try to answer some of Mr. Reyes’ questions.

What is pain? Does it help me in any way?

The ancient Egyptians believed that pain was a sensation felt from the heart that arose from wounds and internal afflictions. Aristotle, the philosopher (384322 B.C.) considered pain to originate from the heart and described it as a quality of the soul which is the opposite of pleasure. The Roman physician Galen (131-200 A.D.) viewed pain as a sensation originating from the brain. Traditional Chinese medicine considered pain as a result of imbalance in the two opposing life forces in the body, the Yin and the Yang. They believed that restoring the balance would eliminate the pain.

The word pain arose from the Latin “poena” meaning punishment. This concept closely linked pain to sin committed by the sufferer. In this view, pain may possibly be relieved by prayer or some type of offering. Most of us may be familiar with the close ties between pain, sin, and punishment in the writings, artworks, and cultural beliefs that have been preserved throughout the centuries.

In the simplest definition, “pain is what hurts,” or “pain is what the sufferer says it is.” We have to understand that pain is a very personal experience. No two persons can ever feel the same pain. The statement, “I feel your pain,” is nice to hear, but is not true. Pain was defined in 1986 by the International Association for the Study of Pain (IASP) as an unpleasant sensory and emotional experience associated with tissue damage. Pain usually drises from tissue damage. There are two types of pain based on the length of time it persists. Acute pain is hurt of recent onset and probable limited duration (e.g. pain from a needle puncture), chronic pain is hurt which remains even when the damaged tissue has healed.

Pain is carried through nerves known as C-fibers, A-deltafibers, and A-beta-fibers. These nerves also carry the sensation for temperature changes. These nerves send impulses from the skin, muscles, bones, and other parts of the body centrally to the brain. The brain processes the impulses it receives and tells us that the sensation is painful. We must understand that acute pain does have a purpose. It is an alarm that tells us something is wrong with our body. It tells us that we may be injured or sick. We can then do the needed things to take care of ourselves before we become even more sick or injured. Pain acts as a warning of potential damage.

What can be done to control my pain after my operation?

In the context of modern medicine and surgery, acute pain only has benefits for a short time, after which it causes more harm than good. Scientific studies have shown that the proper relief of acute pain in patients decreases the hospital stay, medical costs, complications, and deaths. In addition, unrelieved pain has been shown to decrease levels of insulin in the body and cause high blood sugar. This may result in difficulty in managing your diabetes after an operation if the pain is not well-controlled.

There are a lot of ways of treating pain after an operation. Among these are the following:
• Epidural pain medications (usually up to 2 days)
• Injectable (or intravenous or IV pain medications (usually up to 4 days)
• Oral pain medications (usually up to 1 week)
• Patient controlled analgesia (or PICA) medications (usually up to 4 days)

Epidural pain medications are given through a tiny tube called an epidural catheter which will be placed in your back by the anesthesiologist while you are in the operating room. Medications such as local anesthetics or opioids are given through this epidural catheter to control your pain. This is a very good way to control pain after an operation. It is painlessly removed after 2-3 days. However it is only effective after operations which are from the chest area down to the feet area and is rarely used for pain control of other types of operations.

Injectable pain medications are given through the intravenous (IV or “dextrose”) line. Medications such as opioids or NSAIDs (non-steroidal anti-inflammatory drugs, similar to the pain relievers we buy over the counter) are given through the IV line. This is a very flexible type of pain control and can be used after any operation as long as you have an IV line. Another advantage of IV pain medications is that these already take effect within a few minutes of injection.

Oral pain medications are taken by mouth. These medications may include opioids or NSAIDs or even a combination of these two drugs. The advantage of taking oral pain medications is that it does not need an epidural catheter or an IV line. Therefore, these medications may be taken even when you have already gone home from the hospital.

Patient-controlled analgesia or PCA is a special way of giving injectable pain medications (analgesia means pain relief). With a PCA pump, you can press a button each time you have pain and the pump will automatically give you a previously programmed amount of medication. You can control how much medication you get depending on the amount you need. With PCA,’you need not call the medical personnel each time you have pain, and you need not be afraid of overdose. Your doctor will set a maximum limit of drug which is safe for you. Above this limit, you will not receive medication even if you continue to press the PCA button. The medications used in PCA are usually injectable opioids.

These medications and techniques may be given in combination (called multi-modal analgesia). This has the advantage of needing a lower dose of each medication and having lower risks of side effects.

How will my doctor know how much pain I have?

This is a very appropriate question. One of the foremost leaders in pain management in our country, Dr. Merle dela Cruz-Odi, once said: “In order to treat pain, one must first see it.” Your pain doctor can use different scoring tools with which you can report the pain you have. Some of the most commonly used are the numeric pain score and the visual analog scale (VAS). With the numeric pain score you will be asked to score the severity of your pain from 0 (no pain) to 10 (worst pain you’ve ever felt) with 5 being moderate pain. With the VAS you will be shown a 10 cm long horizontal line with the left-most point marked no pain and the rightmost point marked worst pain; you will then point which part of the line corresponds to the severity of your pain. That point is measured from the left-most point and is noted as the VAS score (in centimeters or in millimeters).

What can I do to make sure that I will not have pain after my operation?

We cannot be completely sure of zero pain all the time after an operation. But by observing your pain scores and using the choices above for pain treatment, we can properly manage our pain after operation. The usual goal for pain control is a numerical score of less than 3 or a VAS score of less than 3 cm. When you have pain more severe than these scores which is not going away, or is recurring frequently, DO NOT BEAR THE PAIN! Be sure to tell the medical personnel, they will give you something for it. Your role is to be a partner together with your doctor on deciding the best technique for managing your pain. You can ask so that your anxieties and fears will be put to rest. A more relaxed attitude usually results in better pain control and faster recovery. The accurate reporting of your pain score will also be crucial in your pain management. Remember that your medical personnel are not mind readers! They do not know how much pain you are in unless you tell them.

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  1. efrain espino Reply

    hello, i was reading the information about the diabetes,currently i am studying english because i am a nurse and live in mexico.

    your topics have helped me a lot to learn more medical terminology, and practice the english in medicine.



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