Acute Pain Management Guideline Panel. Pain Control After Surgery. A Patient's Guide. AHCPR Pub. No. 92-0021. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. Feb. 1992.

Pain Control Methods You May Be Using
To get the best results, work with your doctors and nurses to choose the 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 as others feel--even those who have had the same operation.

Before surgery
Drug treatment: Take pain medicine.

Non-drug treatment: Understand what operation the doctor is doing, why it is being done, and how it will be done. Learn how to do deep breathing and relaxation exercises.

During surgery
Drug treatment: Receive general anesthesia, spinal anesthesia, or nerve blocks, or take a pain medicine through a small tube in your back (called an epidural).

After surgery
Drug treatment: Take a pain medicine as a pill, shot, or suppository, or through a tube in your vein or back.

Non-drug treatment: Use massage, hot or cold packs, relaxation, music or other pastimes to distract you, positive thinking, or nerve stimulation (TENS).

What Can You Do to Help Keep Your Pain Under Control? These seven steps can help you help yourself.

Before surgery

1. 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.

2. Discuss 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.
• Talk with your nurses and doctors about any concerns you may have about pain medicine.
• Tell your doctors and nurses about any allergies to medicines you may have.
• Ask about side effects that may occur with treatment.
• Talk with your doctors and nurses about, the medicines you take for other health problems.The doctors and nurses need to know, because mixing some drugs with some pain medicines can cause problems.

3. Talk about the schedule for pain medicines in the hospital.
Some people get pain medicines in the hospital only when they call the nurse to ask for them. Sometimes there are delays, and the pain gets worse while they wait.

Today, two other ways to schedule pain medicines seem to give better results.

• Giving the pain pills or shots at set times. Instead of waiting until pain breaks through, you receive medicine at set times during the day to keep the pain under control.
• Patient controlled analgesia (PCA) may be available in your hospital. With PCA, you control when you get pain medicine. When you begin to feel pain, you press a button to inject the medicine through the intravenous (IV) tube in your vein.

For both ways, 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.

4. Work with your doctors and nurses to make a pain control plan.
You can use the form found to begin planning for pain control with your nurses and doctors. They need your help to design the best plan for you. When your pain control plan is complete, use the form to write down what will happen. Refer to it after your operation. Then keep it as a record if you need surgery in the future.

After surgery

5. Take (or ask for) pain relief drugs when pain first begins.

• Take action as soon as the pain starts.
• If you know your pain will worsen when you start walking or doing breathing exercises, take pain medicine first. It's harder to ease pain once it has taken hold. This is a key step in proper pain control.

6. Help the doctors and nurses "measure" your pain.

• They may ask you to rate your pain on a scale of 0 to 10. Or you may choose a word from a list that best describes the pain.
• You may also set a pain control goal (such as having no pain that's worse than 2 on the scale).
• 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.

7. Tell the doctor or nurse about any pain that won't go away.

• Don't worry about being a "bother."
• Pain can be a sign of problems with your operation.
• The nurses and doctors want and need to know about it.

Stick with your pain control plan if it's working. Your doctors and nurses can change the plan if your pain is not under control. You need to tell the nurses and doctors about your pain and how the pain control plan is working.