Pain After Surgery

Pain after surgery is normal and to be expected. If your symptoms become severe and uncontrollable, you should contact your doctor.

Pain after surgery is common. Pain after surgery is also normal and to be expected.

Steps can be taken to minimize or eliminate pain, but pain that gets worse, especially if other symptoms are present, can be a sign of a surgical complication that may need to be checked by the doctor.

Pain after surgery in children

Children who have surgery experience pain just as adults do, and they usually are able to express their pain in one form or another. Most children older than 18 months can use the word pain, and children younger than 18 months often say they are “hurt.”

However, children often have a hard time explaining how much pain they feel. In addition, very young children who cannot speak yet have a more difficult time communicating how much pain they feel. Consequently, the parent must watch the child for nonverbal signs of pain that may include the following:

• Crying
• Poor feeding
• Poor eating
• Poor drinking
• Lethargy
• Sleeplessness
• Unhappy facial expressions

The parent should note how the child is behaving compared to the child’s usual behavior and express that to the doctor. The doctor may use pictures that the child can choose from to indicate where the child feels pain and to what degree. A happy, playful child who is sleeping and eating well is rarely in pain.

Just as children express pain differently, pain management in children can also vary.

• Dosages and availability of pain medications are different in children. In children, dosages are often calculated by weight. Therefore, knowing the child’s weight is important.
• Children may also be influenced by other factors. For example, a child may have a strong fear of the surgical procedure that may last even after the surgery, or the child may believe that the pain of surgery is a punishment for some act. Therefore, explaining to the child what is going to happen and why, both before and after the surgery, is important.
• Having a plan for management of the child’s pain after surgery is important.
  • Discuss the dosages and timing of medications with the child’s doctor.
  • Discuss what other treatments and instruction will minimize pain and anxiety after surgery.

The cutting of the skin stimulates nerve fibers to signal pain. As the body begins to heal, pain should decrease and eventually stop. The amount of time pain lasts after surgery can depend on several factors such as the following:

• A person’s general health
• The presence of coexisting medical problems
• Cigarette smoking

On rare occasions, pain may remain, though the cause of pain cannot be identified. This condition can become long-term pain.

Pain after surgery can be a sign of surgical complications such as the following:

• Infection either in the skin or at another site in the body: Pain with fever (temperature higher than 100°F) or pain with redness, pus, or swelling at the surgical site is often a sign of infection.
• A break in the wound or separation of the wound edges prior to healing (called dehiscence): If the stitches or staples in the surgical wound are not holding the skin together, a dehiscence may be present.
• A collection of blood or other body fluid below the skin (a hematoma or a seroma): This collection of blood or fluid may cause pain and sometimes swelling at the wound site. This collection may have to be drained by a doctor.
• Vomiting or a change in your bowel habits after abdominal surgery: An obstruction in normal bowel functioning can occur following abdominal surgery and often causes pain and vomiting. Similarly, loss of intestinal movement (called ileus) may cause pain, abdominal distention, and vomiting. Both of these conditions need to be checked by a doctor.
• Formation of fistulas (abnormal passages between body structures): For example, a fistula may form between the bowel and the skin. Pain may be present with fistulas, but often only drainage from the surgical site, change in bowel habits, or weight loss may be present. Leaks occur when 2 pieces of bowel have been surgically connected and the connection fails. Bowel contents will leak out into the abdomen and may cause pain, vomiting, or fever.
• Lung complications: Especially after long surgeries or surgeries that require long recovery periods, a lung complication may occur. These complications may include pneumonia or a blood clot to the lung, called a pulmonary embolus, which may cause a cough, chest pain with breathing, fever, or shortness of breath.
• Chest pain: Have a doctor check any chest pain after surgery. People with prior heart problems are particularly at risk for heart attack (myocardial infarction) or partial blockage of the coronary blood vessels (unstable angina).
• Bleeding, either from the wound (external) or into the body (internal): Bleeding complications can range from minor problems to major life-threatening emergencies.
• Chronic conditions: If you have a chronic medical condition that causes pain, such as lupus or rheumatoid arthritis, you may find that surgery makes these conditions worse. Talk to the doctor before and after a surgical procedure to try to minimize the risk of making these conditions worse.

Postsurgical pain may be described in many ways. You may be asked to identify the following qualities of the pain:

• Character—The type of pain, stabbing, sharp, dull
• Location—Where the pain is
• Duration—How long your pain lasts
• Severity—On a scale from 1 to 10, with 10 as the worst pain you have ever experienced
• Radiation—Movement from one location to another
• Movement of pain location
• Things or movements that make pain better or worse

In addition to postsurgical pain, tell the doctor about other associated symptoms such as the following:

• Fever (temperature higher than 100°F [38 ºC])
• Nausea, vomiting, or both
• Constipation
• Diarrhea
• Pus or discharge from the wound
• Redness or swelling
• Shortness of breath

Call the doctor if you experience any of the following symptoms:

• Increase in pain or pain not controlled by prescribed medications: Telling the doctor if the pain is preventing you from breathing normally, eating, walking, or sleeping, is especially important.
• Pain in the chest

Pain accompanied by any of the following (also if experienced without pain):

• Fever (temperature higher than 100°F [38ºC])
• Vomiting
• Constipation or diarrhea
• Shortness of breath
• Bleeding
• Redness, pus, or discharge from wound

Call the doctor if you are unsure of any of your post-surgery instructions.

Go to the hospital’s emergency department if you are unable to reach the doctor quickly or if you experience any of the following symptoms:

• Confusion
• Lethargy
• Severe pain
• Persistent symptoms
• Vomiting
• Fever (temperature higher than 100°F or [38ºC])
• Bleeding
• Chest pain
• Shortness of breath

If you have pain after surgery, you should always contact your surgeon first. If you cannot reach him or her, call you primary care doctor or go to the emergency room. When you are seen for pain after surgery, the exam may include the following:

• Medical history, medications, and surgical history
• A pain history, including increases or decreases in pain and whether your pain prevents you from breathing deeply, performing daily activities, eating, or sleeping
• A physical examination, especially of the surgical site
• Additional tests if the diagnosis is not made with a history and physical exam
• Blood tests may include a white blood cell count for signs of infection, red blood cell counts to look for signs of bleeding, electrolytes to check fluid status, and possibly other tests.
• X-ray images of the chest and abdomen may be obtained to assess possible pneumonia or signs of bowel obstruction or loss of intestinal movement.
• A CT scan of the painful area may be necessary.
• A sonogram may be obtained to look for collections of fluid and gallbladder or kidney stones.

The doctor may prescribe pain relief medication based on the severity of your pain.

• Acetaminophen (Tylenol) is a common over-the-counter pain medication used to treat mild to moderate pain. Follow the doctor’s directions.
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), and naproxen (Anaprox, Aleve) are over-the-counter and prescription pain medications used to treat mild to moderate pain.
• Opioids, such as morphine (Roxanol), fentanyl (Sublimaze), oxycodone (Percolone), and levorphanol (Levo-Dromoran), treat moderate to severe pain and breakthrough pain. Opioids are available in pill, patch, and injectable forms; opioids may be used in a combination pill with acetaminophen, NSAIDs, or aspirin to treat moderate to severe pain. Some examples of opioids include oxycodone and acetaminophen (Percocet), hydrocodone and acetaminophen (Vicodin), and acetaminophen and codeine (Tylenol with Codeine).

One standard plan for post-operative pain management after surgery is acetaminophen (Tylenol) or an NSAID (such as ibuprofen) prescribed at a regular interval for a set number of days, and an opiate or opiate combination pill prescribed for breakthrough pain.

An example might be ibuprofen 600 mg every 6 hours for 4 days, with oxycodone 5 mg 1-2 tablets every 4 hours as needed for severe pain. In this example, ibuprofen is taken for 4 days every 6 hours whether or not pain is present, and oxycodone is available for when pain is felt despite the ibuprofen pain medication.

Indeed, many different medication plans are similar to this example and work just as well. Review your pain management plan with the doctor before and after surgery.

Many people do not want to take their prescribed pain medications for fear of becoming addicted. Becoming addicted to a pain medication when it is used for pain is very rare. In fact, not using the pain medication can be more dangerous.

Some pain may prevent you from taking deep breaths and increase the risk of pneumonia. Other times, pain may prevent you from resuming your daily activities such as walking, eating, and sleeping. These activities are important for a healthy recovery from surgery.

In addition to pain medications, following the doctor’s and/or surgeon’s instructions for wound care and dressing changes is important.

• Rest the part of your body that underwent surgery and, if possible, elevate that part above the heart if the doctor tells you to do so.
• Keep the wound clean and dry.
• Other pain-relieving methods may be prescribed by the doctor, including application of ice wrapped in a towel (during the first 1-2 days) or warm compresses (after 2 days), movement or splinting, relaxation therapy, or other treatments.
• If a particular diet was prescribed, following it is important, especially if you had abdominal surgery.

• If the examination findings are otherwise normal, the doctor may simply change the pain medications or instructions that were prescribed after surgery.
• If the examination uncovers a potential complication of surgery, treatment might range from adjustment of medications to admission to the hospital for surgical treatment.
• If the pain continues and the doctor cannot find a cause, you may have a condition known as chronic pain. This condition is rare, but if the doctor determines that you have chronic pain, you may be prescribed other treatments or referred to a pain management specialist for further treatment.

Continue to monitor the postoperative pain and watch for other symptoms. Make sure you follow up with the surgeon as directed.

Post-surgical pain is to be expected. Pain medicines and proper wound care instructions that are explained to you by the surgeon can reduce the pain. These instructions may include the following:

• When to take pain medicines
• When and if to change the bandages
• What to eat
• What activities you can do
• When it is safe to take a bath
• When to call the doctor
• When to return for a checkup

Because pain is a normal part of the healing process, most people who experience post-surgical pain have a good prognosis; however, postoperative pain can be a sign of serious complications of surgery. The prognosis depends on the type of surgery and the type of complication.