Adult Surgery Pain Management
OPEN strives to give patients and providers the tools they need for pain management. Learn about preparing for surgery, talking with your surgeon, strategies to manage pain such as over-the-counter medications, non-medication options, opioid medications, and COVID’s impact on the opioid crisis. Healthcare providers can find current evidence to support prescribing decisions, best practices for pain management, opioid prescribing recommendations, patient counseling suggestions, and care coordination strategies.
Preparing for Surgery
Pain after surgery is normal and expected. You may hear it called acute pain, because, while it can cause considerable discomfort, it usually begins to get better a few days after surgery. Before surgery, talk with your surgeon about any medications or substances you take as these may impact your pain control. Ask your surgeon what type of pain is expected after surgery and what you should do to control your pain. Options to control pain may include using over the counter (OTC) medications, non-medication options and if prescribed, opioid medications. If you are prescribed an opioid medication, it is important to know the risks, potential dangers and side effects, and how to minimize risk to yourself and others.
Recovery and Pain Expectations
Each person recovers from surgery in their own way, and someone who has the same procedure might have a completely different experience of pain. Pain after surgery is normal and tells you that your body is healing, and you might need to balance activity with rest. It is an uncomfortable but natural part of recovery. While everyone feels pain differently, typically surgery pain is the worst during the first 2-3 days after and then begins to get better.
The GOAL OF PAIN MANAGEMENT is for you to do activities of daily living like:
- Eat
- Sleep
- Breathe deeply
- Walk
Pain may be well-controlled with a schedule of over the counter (OTC) medications like acetaminophen (Tylenol®) and ibuprofen (Motrin®, Advil®). Adding non-medication options to your pain management plan can help to successfully treat pain.
Managing Pain After Surgery
Learn more about how to successfully manage your pain after surgery using over the counter (OTC) medications like acetaminophen (Tylenol) and ibuprofen (Motrin, Advil), non-medication options and using opioids if prescribed by your surgeon.
Before Surgery, Talk to Your Surgeon About:
- Review with your surgeon and ask for recommendations for how to take your medications prior to surgery including:
- Alcohol
- Tobacco
- Antidepressants (like Prozac® or Celexa®)
- Sedatives (like Ambien® or Seroquel®)
- Benzodiazepines (like Valium®, Xanax®, or Klonopin®)
- Stimulants (like Adderall®, Ritalin®, or Vyvanse®)
- Opioids (like Oxycodone®, Vicodin®, or Norco®)
- Any other substances (like Marijuana, Crack/Cocaine, Methamphetamine)
Ask your surgeon about:
- What type of pain you will have
- How long you should expect to have pain
- What you should do if your pain is not controlled
There are many non-medication options that play an important role in managing pain and reducing anxiety. You can use these methods, along with the medications your surgeon has recommended, to help manage pain. Using these methods may allow you to decrease use of opioids or other medications and avoid their side effects.
| Mindfulness or Meditation | Music | Books |
| Calm breathing, like belly breathing or square breathing, can help to relax muscles that are tense because of pain or anxiety. This is called Mindful Breathing. You can also focus your mind and visualize a particular place you enjoy that makes you feel calm, relaxed, and comfortable. | Music may be very comforting when you are experiencing pain or discomfort. Listening to music, singing, or writing songs can help to lessen pain and anxiety. | Before surgery, take time to select a few books that you would like to read while you are recovering. This can help you to feel relaxed and distraction from pain after surgery. |
| Sleep or Relaxation | Ice or Heat | Compression |
| Take time during your recovery to rest and relax. Sleep helps the body heal. | Talk to your surgeon to determine if ice or heat would be helpful to your recovery. | Talk to your surgeon to determine if compression of the surgery area would be helpful to your recovery. Using an ‘abdominal binder’ after surgery can provide comfort especially when moving around. |
| Short walks | ||
| Taking a short walks after surgery is so important! Walking helps to: -Get blood flowing in your body which helps you heal and reduces risk of developing blood clots -Regain your strength and mobility before surgery -Reduce constipation -Improve mood and anxiety |
Using medications like ibuprofen (Motrin or Advil) and acetaminophen (Tylenol), that you can purchase at your local pharmacy, can be very effective at managing your pain after surgery. Each works in different ways to manage pain and can be taken together at the same time.
Ask your surgeon:
- If you can use OTC medications like Motrin or Tylenol after surgery to manage pain
- What dose and how often to take
- Example: For the first 3-5 days after surgery, take Tylenol and Motrin at regularly, scheduled times and then as needed as pain improves
Sample schedule and doses for OTC medications:
| Time | Medication (Dose) |
|---|---|
| 9 AM | TYLENOL (1000mg) MOTRIN (600mg) |
| 3 PM | TYLENOL (1000mg) MOTRIN (600mg) |
| 9 PM | TYLENOL (1000mg) MOTRIN (600mg) |
Give the dose your doctor recommends: It is important to use the dose your surgeon recommends even if it is different from the dose listed on the medication bottle.
Opioid use for Surgical Pain
What is an Opioid?
An opioid is a prescription pain medication that may be prescribed by your surgeon to use after surgery for pain control.
Most Common Opioids
| Generic Name | Brand Name |
|---|---|
| Codeine | Tylenol® #3* or #4* |
| Fentanyl | Duragesic® |
| Hydrocodone | Vicodin®*, Norco®* |
| Hydromorphone | Dilaudid® |
| Methadone | Methadose® |
| Morphine | MS Contin®, Kadian |
| Oxycodone | Percocet®*, OxyContin® |
| Oxymorphone | Opana® |
| Tramadol | Ultram®, Ultracet®* |
*Contains acetaminophen (Tylenol®). Use caution if you’re taking acetaminophen.
Opioid Use
Because of their risks, opioids are not usually the starting point to manage acute pain after surgery. OTC medications like Tylenol and Motrin and non-medication strategies should be tried first to manage pain.
- If an opioid medication is prescribed to you by your surgeon, it is usually only for managing severe breakthrough pain that is not controlled by OTC medications and non-medications strategies.
- Even if you are using an opioid medication for breakthrough pain, you should still continue to use the OTC medications recommended by your surgeon and non-medication strategies.
- As your pain gets better, stop using or use fewer opioids at a time
- Do not use opioids at the same time as alcohol, benzodiazepines, muscle relaxers, sleep aides, or other medications that can cause sleepiness
- If you are pregnant or planning to become pregnant, using opioid medications can cause harm to a fetus, including neonatal abstinence syndrome
- Talk to your Surgeon about a prescription for Naloxone which is a medication that temporarily reverses the dangerous effects of an opioid overdose
Side Effects from Opioids
| Nausea and/or vomiting | Constipation (difficulty having a bowel movement) | Itching |
 |  |  |
| Sleepiness | Slowed Breathing | Impaired motor skills, thinking or judgment. Teens should not drive while using an opioid. |
 |  |  |
Contact your surgeon if you notice any of these side effects.
Risks of Using Opioids
Anyone who uses an opioid, even for just a short time, is at risk for dependence, tolerance, misuse, addiction, and overdose. This risk may be higher in individuals with a history of:
- Substance use disorder
- Tobacco use disorder
- Mental illness
- Long-term (chronic) pain
- Sleep apnea or breathing problems
- Taking opioids for longer than a few days or more often than prescribed
When an opioid no longer has the same effect on your pain as it first did, which means you need a higher dose to control pain. For example, if you are taking an opioid which first worked well for pain, and then later it doesn’t work as well, it does not always mean the pain is worse. Instead, you may have become tolerant to the opioid.
When your body has started to rely on the opioid to function. This can happen even with using an opioid for a short time period, but the longer you take an opioid, the higher the risk. This is one reason why it is important to use an opioid for as short a time as possible. Suddenly stopping an opioid when a person is dependent causes symptoms of withdrawal, such as muscle aches, yawning, runny nose and tearing eyes, sweating, anxiety, difficulty sleeping, nausea/vomiting, and/or diarrhea.
When you take the opioid you were prescribed at a higher dose, more often, or for reasons other than which it was prescribed.
When you develop a brain disease known as Opioid Use Disorder (OUD). People with this condition seek and use opioids even though they are causing them harm.
When your child takes a dose of medication that is too high for them. This affects breathing and can cause your child to stop breathing.
When anyone other than you gets and uses the medication that was prescribed to you. This can happen when you do not safely dispose of an opioid or leave it unattended. Diversion is dangerous because it can lead to misuse, overdose and/or opioid use disorder in others. Sharing or selling an opioid is a felony in the state of Michigan.
Overdose and Death
Opioids can cause slowed breathing and lead to overdose and death. Discuss the following signs and symptoms of an overdose with your family and friends. Cannot be awakened or are unable to speak
- Vomiting or making gurgling noises
- Limp body that may seem lifeless
- Fingernails or lips turned blue/purple
- Extremely pale or feels clammy to the touch
Talk to your surgeon about a prescription for Naloxone which is a medication that can temporarily reverse the dangerous effects of an opioid overdose. Learn more about this medication with OPEN’s Naloxone Initiative.
Tips for Reducing Opioid Risk
- Tell your doctor about any other medications you are taking and if you have a history of opioid misuse or addiction, depression or anxiety, or a family history of addiction
- Do not use opioids along with antihistamines such as Benadryl or sleep medications
- Only use the opioid medication for the reason, dose, and frequency that it was prescribed, and use it for the shortest possible time period. If you do not need it, don’t use it and dispose of it properly.
- Write down what medications you are taking and when. This will help you be sure you’re using the medication only as prescribed.
- Double-check dosing to make sure you’re taking only the amount prescribed.
- Watch for signs of side effects or complications, and if you notice them, contact your provider. Inform your support person(s) if you are taking an opioid, signs and symptoms of an overdose, and if you have naloxone to reverse an overdose.
- Do not share your opioid with anyone else. It is a prescription only for you.
- Practice safe opioid storage and disposal. Learn more with OPEN’s Safe Storage and Disposal Initiative.