Why is pain management important in postoperative patients?

If you’re having major surgery, you may know that an anesthesiologist will give you anesthesia and monitor you while you’re unconscious during the surgery. But you may not know that this medical expert also works with you and your surgeon to make sure you’re comfortable as you recover from your surgery.

After a major surgery, such as a hip or knee replacement, a heart operation, or a procedure on another major organ, you most likely will experience postoperative pain. Your anesthesiologist will help manage this pain using a variety of medications and nonmedication techniques.

Postoperative pain is not just annoying or unpleasant. If it’s not treated correctly, it can sometimes become chronic pain — pain that lasts longer than three months — and become more challenging to manage.

Postoperative pain is not just annoying or unpleasant. If it’s not treated correctly, it can sometimes become chronic pain.

How will the anesthesiologist manage my pain?

In the first hours and days of your recovery, you may be given pain medication through an IV in a vein. This medication may be an opioid, a powerful drug that prompts the release of dopamine — a chemical in the brain that reduces the perception of pain. Once you are awake and alert, you may be given a pump that allows you to give yourself a dose of medication when you need it. The pump is programmed so you can’t give yourself too much medication.

Opioids also can be taken in pill form, and there are different types and strengths of opioids. Your anesthesiologist will determine the specific medication to use based on your type of surgery, pain level, health status, and history.

Postoperative pain also can be managed by other prescription and over-the-counter medications such as ibuprofen (Motrin), acetaminophen (Tylenol), and aspirin (Bayer). Medications like ibuprofen also help reduce inflammation and swelling. Nonmedication alternatives, such as heating pads, ice packs, or relaxation techniques that help with pain or swelling, can be used instead of or along with medications. Your anesthesiologist will assess your needs and work with your surgeon, nurses and others involved in your care to develop the best overall care plan for you.

Anesthesiologists work with your surgical team to evaluate, monitor, and supervise your care before, during, and after surgery—delivering anesthesia, leading the Anesthesia Care Team, and ensuring your optimal safety.

Controlling acute pain after surgery is important not only in the immediate postoperative phase but also to prevent chronic postsurgical pain, which can develop in as many as 10% of patients. A Series of three papers in this week's issue examines postoperative pain management, outlines how and why acute pain can become chronic, what can be done to lessen that risk, and the role of opioids.

In many countries, opioid misuse is escalating, causing thousands of deaths annually. As the Series explores, excessive prescribing of opioids for pain control after surgery is now recognised as an important driver of opioid misuse and related harm. For many, “opioid dependency started with a prescription after minor trauma or surgery”, as Markus Hollmann and colleagues outline in a Comment. Dependency often results in patients requesting repeat prescriptions or buying more opioids online or on the street. Despite attempts to prevent the illegal sale of opioids, online sales are rising in the USA—for example, with the availability of tramadol being a particular problem.

Improvements in perioperative prescribing and a reduction in opioids on and after discharge are needed to have a tangible effect on the opioid epidemic. Some US states, for example, impose limits on how many pills physicians can prescribe per day, and others make continuing medical education a requirement for physicians prescribing controlled substances. The Centers for Medicare and Medicaid Services require consultation between pharmacists and prescribers about high morphine doses in daily prescriptions for many chronic pain patients.

Pain is a highly personal and subjective experience, which is increasingly recognised to be shaped by life events, mood, fear, anxiety, and anticipation, among other influences. Management of postoperative pain is best tailored to the individual, with multimodal non-opioid analgesics used first. Local anaesthesia might have a role, followed by careful prescription of tapering doses of opioids, if needed. Moreover, communication between hospital and primary care needs to improve to ensure opioid prescribing is carefully managed in the community.