It is safe to say that there isn’t a more common urgent concern after surgery than pain control.Optimal initial management of pain is key to a smooth recovery.With the opioid epidemic ongoing, we need more than ever to have a solid understanding of good pain control.Before you leave the surgery center or the hospital, you will have taken oral pain medications that will assure that you will make it home with adequate pain control. As you see below, “multi-modal” or multiple pathway pain control has been shown to ensure the safest and most effective management of postoperative pain.Keep in mind that some postoperative pain is to be expected and a 0-1 level of pain (referencing a 0-10 pain scale) may not be commonly achieved, however a 2-3 level of pain should be attainable with the appropriate use of oral pain medications.

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A. Ibuprofen as the foundation of pain control.   Unless you have kidney disease, gastritis, taking blood thinners or have been told otherwise by a physician not to take NSAIDS (non-steroidal anti-inflammatories), I recommend using Ibuprofen as the foundation of pain control.  Most people will be familiar with use of Ibuprofen for fever, but it is also very effective in treating pain and is an anti-inflammatory that is particularly helpful for postoperative surgical pain where inflammation is a normal response to surgery.  This means taking it soon after you get home from surgery and continuing 600 mg every 6-8 hours until your pain has resolved, which could be for up to 1-2 weeks after surgery.  You likely received a prescription for Ibuprofen, but if you have over-the-counter Ibuprofen at home (Ibuprofen/Advil/Motrin are the same medication), you can use the equivalent dosage of 3 over-the-counter Ibuprofen (200 mg each) every 6-8 hours.  The maximum dosage of Ibuprofen for someone with healthy kidneys is 2400 mg over a 24-hour period.

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B. Oxycodone w/acetaminophen or Hydrocodone w/acetaminophen.  You will have received your first dose of one of these narcotic pain medications before you left the surgery center or hospital.  Oxycodone is a stronger narcotic  than hydrocodone and one of these has most likely been prescribed to you in combination form with acetaminophen (brand name: Tylenol). The addition of acetaminophen allows effective pain relief with less narcotic than oxycodone or hydrocodone alone.  These two pain medications have different central nervous system effects.  The third arm of multi-modal pain management is Ibuprofen, which further lessens the need for narcotics as noted above.

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i. Do I really need to take the narcotic pain medication?  Most postop patients who have anything other than a minor office procedure, require initial pain control that includes a narcotic pain medication.  Our central nervous system tends to set up a pain pathway that is more difficult to intervene, the longer the pain is left unaddressed.  Optimally, the pain is initially managed with multi-modal therapy, then the narcotic is weened off first, continuing Ibuprofen until the pain is nearly resolved.  I would recommend patients take the narcotic pain medications and move about at home during the initial several days postop rather than not taking the narcotics and laying in bed in pain, risking blood clots or pneumonia. 

ii. Will I get addicted to my postop narcotic pain medication? This is a very timely concern as the opioid crisis continues to rage in our society and prescription medications have been found to be associated with this crisis.  However there is no evidence to suggest that using narcotics for 5 days or less after a surgical procedure leads to narcotic addiction.  Although it is unlikely that you will need it to this duration, even up to 2 weeks of gradually decreasing dose of narcotics is safe for most people during the postoperative period.

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iii. Please see the separate section on constipation, as narcotics cause constipation.  Unfortunately, although narcotics are very effective in pain control, our intestinal tract also has receptors for narcotics which cause them to slow down and causes constipation.  This is another reason multimodal therapy is recommended and for weaning off of narcotics as soon as feasible. 

 

C. Local therapies. For the initial 48 hours after surgery, local application of ice packs to the site of surgery can decrease the inflammation and can also improve pain control.

 

D. What if my pain is still poorly controlled despite taking the maximum allowed doses of pain medications?   You should call my office with any pain that is not controlled with the prescribed pain medications.  We are available 24-7 to take your call.