Pain Management

Pain is a complex problem and the staff at the INSTITUTE FOR ORTHOPAEDIC
SURGERY recognizes the importance of managing pain. The following are some
important principles in learning about pain and managing it after surgery. Learning
as much as you can and being prepared helps put you in control.

What is Pain?

Pain is an uncomfortable feeling that tells you something may be wrong in your
body. Pain is your body's way of sending a warning to your brain. Your spinal cord
and nerves provide the pathway for messages to travel to and from your brain to the
other parts of your body. Receptor nerve cells exist in, and beneath your skin, and
they sense heat, cold, light, touch, pressure and pain. You have thousands of
these receptor cells. When there is an injury to your body – in this case surgery –
these tiny cells send messages along nerves into your spinal cord and then up to
your brain. Pain medicine blocks these messages or reduces their effect on your brain.

Sometimes pain may be just a nuisance, like a mild headache. At other times,
such asafter an operation, pain that doesn't go away – even after you take pain
medicine – may be a signal that there is a problem. After your operation, your nurses
and doctors will ask you to rate your pain on a scale from one to ten. They want you to be
comfortable, but also because the pain scale rating can help them to determine if something is wrong. Be sure to tell your doctors and nurses when you have pain.

Before Surgery

Ask the doctor or nurse what to expect.

• Will there be much pain after surgery?
• Where will it occur?
• How long is it likely to last?

Being prepared helps put you in control. You may want to write down your questions before you meet with your doctor or nurse.

• You may receive a nerve block before surgery to block the pain messages being sent to the brain.

Discuss the pain control options with your doctors and nurses. Be sure to talk with your nurses and doctors about:

• Pain control methods that have worked well or not so well for you before.
• Any concerns you may have about pain medicine.
• Any allergies to medicines you may have.
• The medicines you take for other health problems. Mixing some drugs with some pain medicines can cause problems.
• Talk about a schedule for pain medicines.

Some people get pain medicine in the hospital only when they call the nurse to ask for them and there can be delays. Giving the pain pills or shots at set times, instead of waiting until pain breaks through, seems to give better results. You may receive medicine at specific times throughout the day to keep the pain under control. Your nurses and doctors will ask you how the pain medicine is working and change the medicine, its dose, or its timing if you are still having pain. Either way, your doctors and nurses will know how the pain medicine is working and change the medicine, its dose or its timing if you are still having pain. With a nerve block, depending on the type, you may not have as much pain and may require less or no pain medication.

Pain Control After Surgery – A Patient's Guide

The following information explains the goals of pain control and the types of treatment you may receive. It also shows you how to work with your doctors and nurses to get the best pain control.

This information should help you:

• Learn why pain control is important for your recovery as well as your comfort.
• Plan an active role in choosing among options for treating your pain.

Help the doctors and nurses measure your pain.

• Reporting your pain as a number helps the doctors and nurses know how well your treatment is working and whether to make any changes.
• They may ask you to use a "pain scale" like the one shown below.

Treatment Goals

People used to think that severe pain after surgery was something they "just had to put up with." But with current treatments, that's no longer true. Today, you can work with your nurses and doctors before and after surgery to prevent or relieve pain.

Pain Control Can Help You:

• Enjoy great comfort while you heal.
• Get well faster. With less pain, you can start walking, do your breathing exercises and get your strength back more quickly. You may even leave the facility sooner.

Pain Control – What are the Options?

Both drug and non-drug treatments can be successful in helping to prevent and control pain. The most common methods of pain control are described below. You and your doctors and nurses will decide which ones are right for you. Many people combine two or more methods to get greater relief. This is multimodal therapy and is used at IOS. Don't worry about getting "hooked" on pain medicines. Studies show that this is very rare – unless you already have problems with drug abuse.

Pain Control Methods – You May Be Using After Surgery

To get the best results, work with your doctors and nurses to choose methods that will work best for you. Your nurses and doctors want to make your surgery as pain free as they can. But you are the key to getting the best pain relief because pain is personal. The amount or type of pain you feel may not be the same others feel – even those who have had the same operations.

Drug treatment: Take medicine to alleviate pain as a pill, shot, suppository, an IV or nerve blocks. You may also be given Non-steroidal anti-inflammatory drugs on a scheduled basis.

Peripheral Nerve Blocks: Described next.

Advanced Specialized Techniques:

Peripheral nerve blocks for post-operative pain management.

What is peripheral nerve block?
A peripheral nerve block is a procedure performed by an anesthesiologist who will place medication (local anesthetic) close to a nerve that supplies a particular part of your body such as your shoulder, foot, hand, or knee.

What types of PNB (peripheral nerve blocks) are there?
There are two types of peripheral nerve blocks. One is called a single shot injection. A single shot is a one time injection of medication lasting 12 – 24 hours. The other is a Continuous Peripheral Nerve Block (CPNB). With a CPNB, your anesthesiologist will place a tiny hollow tube next to your nerve and a continuous infusion of local anesthetic will keep you comfortable for up to 3 days.

How quickly will my block start to work?
There is a wide variation in how quickly your block will take hold. The medication chosen for your block is long lasting and may require at least 30 minutes to take effect.

Will the block take away all my pain?
Depending on the procedure performed and the block administered, pain medication may need to be given to maximize your comfort. It is vital to tell your nurse if you are experiencing any discomfort.

How will I feel after the procedure?
After receiving your block, you may initially notice a tingling, warmth, or numbness to your extremity. It is very common to temporarily lose strength, or to be partially or completely unable to move your extremity. This IS normal and expected. When the block wears off, your strength and sensation will return.

Is it painful to receive a block?
Generally, most people tolerate these procedures well, although some discomfort should be expected. You will be offered IV medication to relax you, and make the experience more comfortable.

What types of side effects can I expect?
Depending on your particular block, different side effects can occur. Generally, heaviness, numbness, or inabilities to move the blocked extremity are most common. It is very important to be careful with the extremity and protect it.

After Discharge

Take (or ask for) pain relief drugs when pain first begins. Choose the proper medication according to the type and intensity of your pain.

• For the first two days after your surgery, you may require pain medication that was prescribed for you by your doctor.
• After the first couple of days as your pain level decreases, you may only require over-the-counter medication similar to what you would ordinarily take for minor aches and pains, but prescription medications should be taken as long as needed.
• Don't worry about getting "hooked" on pain medicines. Studies show that this is very rare – unless you already have problems with drug abuse. The prescription that you are sent home with should be what you need to relieve your more intense pain.

Our team is here to answer any questions you may have. Your comfort is very important to us, and your feedback is welcome.

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