Understanding Postoperative Pain
There’s surely a good reason for that surgery you scheduled. Unfortunately, that (hopefully) permanent fix may come with a (hopefully) temporary downside.
Reading a blog post about postoperative pain won’t make it go away, but will help you understand it better. Let’s start by looking at the types of pain you may potentially experience, which will depend of course on the type of surgery.
This is the type of pain we typically experience after burning a finger on the stove, getting a root canal, or twisting an ankle. It can really hurt initially, but that sensation tends to diminish over time as the impacted area heals.
With regards to an operation, this residual pain can come from the surgical incision, which the body interprets as a superficial skin ‘wound.’
Or, it can go deeper, if the surgeon had to cut through muscles, tendons or ligaments to either repair that tissue, or to get through it to access something else.
Visceral pain is usually associated with an internal organ; if you’ve ever had appendicitis, you know what we’re talking about here.
If your surgery involves an organ such as the heart, stomach or kidneys, then that organ is going to be impacted in ways that nature hadn’t planned for. Pain, after all, is nature’s way of telling you that something’s not normal.
This kind of pain is associated with damage to nerve cells, and can occur when a nerve along the spinal column, emerging from the spinal column, or in a limb is compromised due to an injury or the physical wear-and-tear of surrounding structures.
After surgery, Central Neuropathic Pain can result from damage to nerve cells in the brain or spinal cord. That damage can be unavoidable if the surgery involves the nervous system itself, or it can be accidental, due to the proximity of those nerves to the area that is being worked on.
Peripheral Neuropathic Pain is similar, but occurs most often with nerve cells in the limbs; for example after joint repair or replacement surgery.
This one can be a little tricky, since the experience of pain can be in a different part of the body than the actual source of the pain.
This happens because information traveling along the nerves from the body to the brain is often ‘bundled’, making it harder for the mind to interpret it.
Pain from Inflammation
This occurs when the body naturally responds to an internal injury or invasive factor (including the surgeon’s scalpel) by rushing blood to the area to protect it and begin the healing process.
That swelling can press on nerves, organs and other structures, and the result is, you guessed it, more pain. The good news is, that pain generally diminishes when the inflammation does too.
Persistent Postoperative Pain
Your pain should go away little by little, within a few weeks. For some major surgeries, it may take a few months. But if you still can’t get relief, it’s considered Persistent Postoperative Pain.
This lasting pain is most often associated with injury to a major peripheral nerve during surgery (Peripheral Neuropathic Pain). Some types of operations are more prone to this problem than others, including hernia repair, breast surgery, and thoracic surgery.
Researchers have found that there may be a genetic predisposition to longer-lasting pain. The person’s emotional make-up can also be a factor.
What can be done to minimize post-op pain?
The doctors’ task is to anticipate the ‘pain pathway,’ then plan measures that will help prevent the pain in the first place rather than preempt it just before sequential surgical procedures trigger it.
Their toolbox includes local anesthetics to infiltrate the incision site; regional nerve blocks or epidural analgesia, and NSAID anti-inflammatories. Each is introduced according to a pre-op-to-post-op timeline.
What can I do during recovery to keep postoperative at bay?
Pain medication is the first step, of course. It won’t make the ache disappear completely, but it will help make it tolerable.
If the pain refuses to let up, or if it gets worse, let your surgeon’s office know. You may just be healing on the slow side, but if there’s a more serious problem, such as infection, you (and your surgeon) will want to know about it sooner rather than later.
Pain from Complications
Contact your surgical team if something doesn’t seem right during recovery. It could be an infection, or something worse, like a blood clot or pulmonary embolism.