Undergoing surgery is the ultimate stressful lifetime event. The physical battering, combined with the time spent in the unfamiliar environment of the hospital and the worrying before the procedure easily ratchet up a person’s stress level.
But the surgery i
s just the beginning. As soon as the stitches are tied and the patient is returned to the room, recovery begins.
For many patients, the road to recovery is not a smooth one, made rougher by post-surgical pain.
The American Pain Society has recently published its own set of clinical practice guidelines, to be used for treatment of post-surgical pain control. The publication’s lead author was Dr. Roger Chou.
Post-surgical pain management faces a few obstacles including communication issues regarding the patient’s perceived severity of pain and the physician’s understanding of the pain levels, staffing issues in recovery settings which can impede proper monitoring of pain levels, and the use of opioids in the general population. Opioid users often develop a strong tolerance to pain medication and are not as responsive as other members of the public to a typical pain regimen.
The guidelines divide their recommendations based upon evidence. They list recommendations which are backed by high quality of evidence, those that are backed by moderate evidence and those that have weak evidentiary underpinnings (but may have anecdotal evidence.)
Among the strong evidence recommendations are the use of acetaminophen (Tylenol) as well as other non-steroidal anti-inflammatory medications for pain relief for nearly all patients as well as site-specific pain treatment (local anesthesia). The study also recommends that every hospital and surgery center retain a qualified pain specialist on staff. The study also deals with the administration of pain medications, including opioids, recommending that they be given orally and not intravenously, if possible. Furthermore, the study recommends that all patients be individually counseled regarding pain relief during recovery, taking into account their current use of all pain-relief medications and procedures.
Surgery is already tough enough. It’s important for health care teams to be “on the cutting edge” of post-surgical recovery and pain abatement.