Post-op pain: You don't have to suffer from it

Before an operation

Before an operation

Suffering from pain after surgery is one of the most feared experiences in medical care. Yet this fear is unnecessary. Why? Because pain is largely preventable.

Here's what you can do to prevent pain after your surgery.

n Before surgery, discuss with your doctor the pain-relief strategies you both plan to deploy. No surgical outcome is improved by the patient having pain. Both the surgeon and you want to minimize discomfort so that you can focus on your recovery exercises.

n Take oral nonnarcotic pain medication such as Celebrex, if allowed by your doctor, the night before and the morning of surgery.

n Ask your surgeon to deploy the newest long-acting local-pain medications at the site of surgery before any incision is made. New versions of the traditional lidocaine numbing medications are bound to slow releasing fat molecules and provide three days of anesthetic. They are so effective that many total joint replacement operations are now moving to outpatient centers as the patients can go home the same day.

n Discuss with your anesthesiologist the use of regional blocks that also provide long-acting pain relief.

n Find the combination of nonnarcotic plus narcotic medications that relieve post-op pain, yet minimize the nausea normally associated with them. We use T&T first, Tylenol and Toradol, because they are great pain relievers without the narcotic downsides. When combined with ice, elevation and soft tissue massage, narcotics can often be avoided.

n On the ice story, newer sequential-compression ice machines, such as GameReady, relieve pain by decreasing swelling and local cooling.

n Use enough medication. Many patients are scared of using too much, then underdose and suffer needlessly. It is unlikely that we will make you an addict after a couple of weeks of needed medications. However, it is likely you will be miserable if pain is not controlled.

n Prepare mentally. Remember the Buddhist advice that you can have pain but not suffer from it. This mental preparation dramatically improves your ability to work with the symptoms and discomfort any surgical procedure has, yet not suffer from the underlying pain.

n Use alternative methods if they work for you such as acupuncture, electrical stimulation and meditation. The wide variation in people's response to these modalities is always surprising. When they work, they work without side effects.

n The role of THC (tetrahydrocannabinol) and CBD (cannabidiol) and other medical compounds extracted from cannabis is being evaluated in several studies. There probably is an important role for drugs that cause disengagement, mellowness and euphoria in the postoperative time. The dosing and FDA approved recommendations are not yet available.

We always note that happy, relaxed patients coming into surgery carry that state with them throughout the treatment and often have a positive effect on the surgical and rehabilitation teams. Building confidence in your decision to have surgery and in the team you have chosen to care for you before you enter the surgical theater helps tremendously. Know your doctor, nurses and therapists. Impart your confidence and happiness and the reflection will be real and useful to you.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments. For more info, visit www.stoneclinic.com.

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