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Pain Management

Pain Management

The class of painkillers is very wide, and there are many classifications of drugs used in practice. The main analgesics are paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioids and local anesthetics.

Types of painkillers

Drugs that have an analgesic property and are used in the treatment of pain syndromes of various localization include drugs for the relief of pain associated with changes in the pain threshold, damage (or dysfunction) of the structures of the central and peripheral nervous system, such as flupirtine, drugs from the class of antidepressants, groups of anticonvulsants. Also, there are drugs that do not have an anesthetic effect but enhance the analgesic effect of other drugs.

Pain is a subjective and unpleasant sensation that affects consciousness and impairs well-being. Acute pain is short-term, most often it has a clearly defined zone, a certain start time, and also subjective and objective physical symptoms: heart rate and breathing become more frequent and blood pressure rises.

Severe pain interferes with sleep and creates a feeling of fear and anxiety. Acute postoperative pain occurs due to a surgical procedure or operation. The strength of the pain depends on the severity of the operation, the size of the surgical wound, and on the threshold of a person’s pain. People feel and react to pain in different ways. The patient’s early experience with pain, his or her age, gender, cultural characteristics, as well as psychological factors can also affect pain. In the case of children, the attitude of their parents to pain can also affect pain.

Why is acute postoperative pain treated?

Postoperative pain does not need to be tolerated, as the frequency of manifestations of postoperative complications may increase due to pain: recovery after surgery will be slower and therefore the time spent in the hospital may increase. Left untreated, chronic postoperative pain may occur more often. Effective treatment of postoperative pain facilitates the functioning of the heart and lungs, reduces the risk of venous thrombosis and helps to normalize digestion.

How is pain strength evaluated?

Assessing the strength of pain after surgery is a common part of patient monitoring. Pain is assessed regularly, the frequency of assessment depends on the patient’s condition and the severity of the operation. Since the pain sensation is individual and subjective, only you yourself can appreciate the strength of the pain experienced. The nurse will evaluate your pain regularly, both before and after taking painkillers, both during rest and during movement. Based on the information received, it will be possible to draw up a pain treatment scheme that suits you personally.

There are different pain scales that are used to evaluate pain. For example, a scale for digital evaluation is used in adults. Using it, they evaluate the strength of pain on a ten-point scale, where zero means that there is no pain, and 10 means the most severe pain you can imagine. The patient is asked to evaluate the pain experienced in the last 24 hours. Sometimes the patient is asked to choose words that describe his/her pain. These words can be:

  • no pain;
  • slight pain;
  • moderate pain;
  • strong pain;
  • very severe pain;
  • unbearable pain.

Sometimes, a face scale is used to assess pain. This scale can be used, for example, in older children. The very leftmost face shows that there is no pain at all. Other faces show that the pain is getting stronger and stronger. The rightmost face shows that there is unbearable pain.

pain assessment

According to the face selected by the child, the evaluator will be able to give the indicated pain an estimate of 0, 2, 4, 6, 8, or 10 points: 0 = not at all painful. 10 = very painful.

The above scales are used not only for assessing pain in older children but also for patients with a mild or moderate mental disorder. For young children, infants and patients with severe mental illness, a scale of behavior is used, in which case the nurse evaluates the strength of the pain. For such scales for assessing the pain strength, a specialist takes into account such vital indicators of the patient as the heart rate, blood pressure, oxygen content in the blood and behavior (facial expression, anxiety, sleep).

To achieve the best result in the treatment of pain, you need to inform the nurse if you feel pain – even when the pain is mild or if it occurs at night. Do not bear the pain!

How to treat pain after surgery?

To treat postoperative pain, doctors use different drugs with different methods of administration. In addition, it is allowed to use alternative methods that can be used in case of mild to moderate pain.

To create a suitable pain treatment, it is important to know which medications (including painkillers) you have already used, whether you are allergic to medications, or whether there were side effects.

The choice of a suitable pain medication, the dose of the medicine and the duration of treatment depends on the strength of the pain (mild, moderate or severe pain), the type of pain (wound pain or nervous pain), the person (elderly, child, pregnant, etc. ), as well as on concomitant diseases.

For best results, the patient should take painkillers regularly (at regular intervals). Often painkillers of different effects are combined.

Groups of pain medication

Painkillers are divided by the type of mechanism of action into three main groups:

  1. Simple painkillers. For example, paracetamol, ibuprofen and diclofenac;
  2. Opioids. Drugs in this group are divided into weak opioids – for example, tramadol, codeine, and strong opioids – for example, morphine;
  3. Supportive drugs. They are used, for example, to treat nerve pain.

Pain medications after surgery and their side effects

Paracetamol

Paracetamol is often the primary choice for mild to moderate pain. Paracetamol differs from other painkillers (for example, from ibuprofen and diclofenac) primarily in that it does not have an irritating effect on the digestive tract mucosa. Paracetamol rarely causes side effects. The most severe possible side effect is liver damage, which is rare and occurs most often due to an overdose of the drug. Paracetamol should be used carefully for hepatic and renal failure, chronic malnutrition, or alcoholism. Paracetamol should be given to a child according to his or her age and weight.

If additional medicines are used, which include paracetamol in combination with an anesthetic, you need to ensure that the amount of paracetamol taken per day does not exceed the allowable daily dose (for adults – 4 grams per day).

Nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, ketoprofen, dexketoprofen, naproxen, etc.)

If the analgesic effect of paracetamol is too weak (an hour after taking paracetamol, a patient still feels mild or moderate pain), he or she need to take, for example, ibuprofen, ketoprofen, naproxen, diclofenac or other drugs from the same group according to the instructions for use.

These drugs have analgesic, antipyretic and anti-inflammatory effects but their use is contraindicated in case of an ulcer of the digestive tract. These drugs should be used with caution in patients who have cardiovascular disease. The risk of side effects in the digestive tract is greater in older people and those who take NSAIDs in large quantities. The occurrence of side effects in the digestive tract does not depend on the method of taking medications – medicinal suppositories with NSAIDs and injectable forms of drugs are also not suitable for patients with ulcers in the digestive tract. The strength of the harmful effects on the digestive tract differs in different drugs of the NSAID group. It is believed that ibuprofen does the least harm to the digestive tract.

Depending on concomitant diseases, some painkillers belonging to this group may be more suitable for you than any other, and this should be taken into account when choosing a pain management scheme. Children usually receive ibuprofen (according to the age and weight of the child).

Opioids or narcotic painkillers (codeine, tramadol, morphine, fentanyl, oxycodone, pethidine, etc.)

In case of severe pain, opioids are used in addition to the above groups of drugs. Common side effects of opioid use are nausea and vomiting. The opioid effect that causes nausea is weakened by their long-term use. Another common side effect is constipation.

Supportive medications (gabapentin, pregabalin).

Supportive drugs are those that were not originally created as painkillers but their beneficial effect was later discovered to relieve certain types of pain. For example, gabapentin and pregabalin were used initially to treat epilepsy. Often, such medications are used to treat chronic nerve pain. They are also effective for the treatment of postoperative pain, they reduce pain and the need for other painkillers.

Routes of analgesic medication administration

After surgery, painkillers can be taken:

  • through the mouth;
  • through injections into a vein or muscle;
  • through an epidural catheter;
  • using a medicinal candle.

Oral painkillers are a preferred pain management method. A medicine taken by mouth is as effective as an injection, and it is not accompanied by pain or complications caused by injections, such as hemorrhage, inflammation of the injection site. Oral painkillers are suitable for easing any type of pain but the patient must still be able to eat and drink.

Is pain relief possible without medication?

The effect of pain treatment alternative methods after surgery is small, so you should not use such methods separately but only together with painkillers. Alternative methods reduce anxiety and tension throughout the hospital stay. Most methods — for example, music therapy or distraction — are safe, and you can use them in this way without special training and additional tools. If the pain is mild or moderate, then in addition to painkillers, you can use the methods from the list below.

Cold compress

Cold leads to a narrowing of blood vessels and bleeding in the damaged area slows down. If you have no contraindications, you can reduce swelling and pain in the area of ​​the operation with a cold compress. You can also use special gel bags sold in pharmacies, any package from the freezer is also suitable. Wrap a cold bag in a towel and then place it on the damaged spot and fix the compress if necessary. The towel protects the tissue from possible local exposure to cold. Keep the cold compress in place for 20-30 minutes, then make a 10-15 minute pause and repeat the procedure if necessary.

Transcutaneous electric nerve stimulation (TENS)

TENS passing through the skin is a method of pain management, in which electrical impulses are used to reduce postoperative pain.

Physiotherapy

Physiotherapy is recommended to be added to the postoperative treatment regimen, as it reduces the risk of complications and facilitates the recovery of the body after surgery. Physiotherapy is carried out by a specialist, who will explain to you why it is necessary to start moving as soon as possible after the operation, teach you how to take the most comfortable and relaxed posture after the operation, how to support your body with pillows or the operating area with a dressing. In addition, the specialist will teach you breathing techniques, as well as motor exercises.

Music therapy

Listening to music reduces anxiety and stress, slightly reduces the strength of postoperative pain. Therefore, the need for opioids is also reduced.

If you like listening to music and it relaxes and soothes you, we recommend that you take your favorite music with you to the hospital. You just need to remember that other patients may not like your favorite music, so we recommend that you use headphones when listening to music.

Psychological methods

This includes various relaxing techniques, training in everyday independent activities, distraction, and positive visualization techniques.

Using different psychological methods throughout your stay in the hospital will help you reduce feelings of tension and anxiety. They will help you easily cope with the situation. The strength of pain and the need for painkillers will decrease to a small extent.

To distract attention, you can solve crosswords, add mosaics, play electronic games, etc. You can also use a relaxing technique to relax specific muscles or to reduce the general feeling of anxiety and tension.

In the case of children, it is also important to use different psychological techniques to reduce feelings of anxiety and pain, and to do this throughout your stay in the hospital. Children become calmer if they are told what is awaiting them at the hospital.

An effective method of distraction for the child is the game: both during the postoperative period and during the procedures. Those games in which the child will be an active participant (for example, electronic games) are more effective than the usual distraction.

Listening to your favorite music is especially good at reducing pain and anxiety in older children. For newborns, physical contact is important (being on the mother’s or father’s chest). Massage will also be useful for reducing pain during the procedures and after the surgery.

How to deal with postoperative pain at home?

When you are discharged from the hospital, you will be given recommendations on the treatment of pain at home: which painkillers you may need, at what dosage and for how long. The doctor will also inform you about possible side effects and what to do when they occur. Painkillers for home use may not necessarily be the same as the ones you received at the hospital.

Ask your doctor where you can go if you have problems. Make sure your doctor is notified of any medications that previously caused side effects. This will help to avoid possible complications associated with drugs.

If you feel pain at home:

  • Take painkillers regularly as directed by your doctor;
  • Have a good rest. If you have trouble sleeping, tell your doctor;
  • To reduce pain, you can use alternative methods approved by your doctor: cold or warm compresses, listening to music, massage, replacement therapy (being in a position that alleviates pain, supporting your body with pillows, etc.);
  • If you must use opioids at home to treat acute postoperative pain, then driving will be prohibited, and you will not be able to use devices/mechanisms that require special attention;
  • If the painkillers prescribed by your doctor do not reduce the pain (the strength of the pain on a ten-point scale is still more than five), then contact your doctor or family doctor.

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