Pain after surgery

introduction

Thousands of operations are carried out in Germany every day. The spectrum ranges from the smallest of procedures, such as the removal of skin warts, up to major surgical interventions lasting several hours. After each of these operations, pain can occur in the area of ​​the body that was operated on. This pain, which is caused by an operation, is called postoperative pain.

What kind of pain is normal after an operation?

Hardly any other area of ​​medicine is so dependent on subjective perception as pain therapy. The perception of pain is individual, which means that every person has their own threshold from which a sensation is described as painful and to which he relates the strength of pain. An objective assessment and definition of what is “normal” after an operation is therefore relatively difficult in the field of pain medicine.

A frequently used aid, especially to be able to follow the development of pain in the days after an operation, is the numerical rank scale. The patient is asked to rate his pain with a point value between 0 and 10, with 0 representing no pain and 10 representing the worst imaginable pain. Of course, we always try to keep the pain as low as possible. On the scale, this corresponds roughly to a point value below 3, which still represents a moderate pain intensity.

In addition to the intensity of the pain, the nature of the pain also plays a very important role, as it can provide information about the cause of the pain. After an operation, the so-called nociceptive pain occurs in particular. This describes the typical wound pain. It is easy to localize, tends to be sharp and sharp and increases with certain movements or touches of the wound. Depending on the operation, neuropathic pain can also occur. These arise as a result of a nerve injury. In contrast to wound pain, the characteristic of pain is burning, is often perceived as suddenly shooting in and can be associated with reduced or impaired sensitivity. Because of these different characteristics, it helps if the pain is precisely described to the attending physician. He is then also able to assess which pain can be expected after the respective operation and which are a warning sign.

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Causes of pain after surgery

The most common cause of postoperative pain is tissue damage caused by the surgery. As part of this injury, cells are damaged. Certain substances, so-called neurotransmitters, are then released from these cells. In the area of ​​the wound, these neurotransmitters now hit the free ends of nerves and trigger a signal in them. This signal is transmitted via the nerves and the spinal cord to the brain, where it leads to the perception of pain.

Inflammation can lead to pain through the same mechanism. These are another common cause of pain after surgery. A surgical wound offers a good entry point for various pathogens. It is therefore very important to ensure correct wound care and, above all, adequate hygiene after an operation.

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Other triggers of postoperative pain are injuries to nerves during surgery and postoperative complications, such as Bleeding or loosening of sutures. A precise description of the pain in terms of strength, character, as well as localization and radiation can often provide a lot of information about the cause of the pain, which can then be resolved and treated in a targeted manner.

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Concomitant symptoms

Just as the pain characteristics differ, postoperative pain, depending on the cause, can also be accompanied by different accompanying symptoms. Typical for this are e.g. the classic signs of inflammation. In addition to pain, these include reddening of the affected body region, as well as swelling, overheating and possibly a functional restriction. A slight inflammatory response is normal with any tissue injury. However, if the symptoms become very severe, worsen or the wound starts to fester, it is a wound infection, e.g. with bacteria, to be considered as the cause of the inflammation. The wound should then be examined and treated by a doctor.

In addition to inflammatory pain, neuropathic pain that occurs after a nerve injury is also associated with typical side effects. These consist of an increase or decrease in sensitivity in the affected area as well as possible abnormal sensations such as persistent tingling or stinging.

Depending on the severity, pain can also lead to so-called vegetative symptoms. These consist e.g. increased heart rate, high blood pressure, increased sweating, nausea or vomiting. However, these usually subside very quickly after the administration of painkillers.

Swelling in pain after surgery

Swelling can have numerous causes, especially after an operation. A slight swelling around the surgical wound is normal and part of the body's natural repair processes. It should go away on its own after about 2 weeks. However, painful swelling can also be a sign of complications. This can e.g. be the case if additional skin reactions such as pustules occur, secretions such as e.g. Pus comes on, or unilateral leg swelling occurs as a sign of thrombosis. A doctor should therefore always be consulted in case of uncertainty.

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What can you do against pain after an operation?

There are a number of options available to alleviate postoperative pain.

In the non-drug treatment, the main focus is on protecting the affected body region. However, this does not mean strict bed rest. This is actually rather counterproductive when it comes to "getting back on your feet" after an operation. Rather, sparing is about avoiding tension and pressure on the surgical wound through conscious movements and techniques during activities such as getting up or walking, and through correct positioning when lying down.

The application of cold or heat can also have a relieving effect on the pain. Here we recommend e.g. Cool packs or heating pads. Other physical therapy measures that can be used to treat pain are manual applications, such as the lymphatic drainage or massages. Breathing and inhalation therapy also show a clearly positive effect.

Just as the sensation of pain is very subjective, the effectiveness of a therapy method can also vary greatly from person to person. Good communication between the patient and the treating doctor or therapist is therefore of great importance.

Which painkillers help against pain after an operation?

The drug treatment of pain is usually based on the WHO level scheme. This is based on the severity of the pain and comprises three levels:

1. The first stage are the so-called non-steroidal anti-inflammatory drugs, such as Ibuprofen or paracetamol.
2. On the second level are weak opioids.
3. The third stage involves strong opioids.

As far as the pain intensity allows, an attempt is usually made to go back to the lower level of medication as quickly as possible, since strong medication is of course often associated with stronger side effects. The drugs of the 1st stage have different action profiles, which allows a more specific selection with regard to the cause of pain. A commonly used drug is metamizole. This has a particularly good analgesic and antispasmodic effect, but has no effect on inflammation. Diclofenac or ibuprofen are therefore more recommended for inflammatory pain. In addition to a good analgesic effect, these also have an anti-inflammatory effect.

In general, however, self-treatment with medication should never take place, especially after an operation. In addition to their pain-relieving properties, pain medication in particular has an impact on the entire body and is therefore associated with a whole range of possible side effects. It is therefore recommended that you always consult your doctor in depth.

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Home remedies

In addition to pain medication, various home remedies also have good pain relieving effects. Cold packs and the protection of the affected body region can contribute to a significant improvement in the symptoms. Various plants also have pain-reducing properties. These are e.g. Devil's claw, willow bark or nettle extract. An often overlooked aspect of pain is the stiffening of the discomfort. General things such as regular walks, conversations and relaxation exercises can also help to distract from the pain and also support healing.

Duration of pain after surgery

Just like the pain intensity, the duration of the pain after an operation can also vary greatly. This depends, among other things, on the size and severity of the procedure. After a small operation, the surgical area will heal much faster and be pain-free than e.g. after extensive abdominal surgery which resulted in major tissue damage. Furthermore, the personal constitution before and after the operation, possible concomitant illnesses as well as behavior in the time after the operation and how exactly the instructions of the doctors, nurses and therapists are followed play a very decisive role in the course of the recovery phase.

Pain after breast surgery

The choice of the appropriate anesthetic method before the operation has a major influence on the development of pain and its treatment in breast operations.

In addition to general anesthesia during the operation, the so-called thoracic paravertebral block is used for interventions on the chest. The medication is injected into a rib on the patient's back. The drug acts directly on the nerves that supply the ribs, chest wall and armpit. By using long-acting substances, pain in the surgical area can be eliminated for up to 48 hours after the operation. The usual pain medication can then also be used. Significantly lower doses and thus fewer side effects are among the positive effects of the procedure.

In addition to medication to treat pain, it is particularly important to avoid any tension or force on the surgical scar after a breast operation. This should be taken into account when making movements such as getting out of bed, as this tenses the chest muscles. In addition, cold applications and ointment bandages can significantly reduce the pain after breast surgery.

Pain after hernia surgery

Adequate pain therapy is particularly important after a hernia surgery. In addition to improving the patient's well-being, this also serves to avoid undesirable complications. These can e.g. consist in improper stress by taking a relieving posture or in constipation by avoiding the abdominal press.

Depending on the intensity of the pain, non-steroidal anti-inflammatory drugs or combinations with opioids are used after hernia surgery to relieve the pain. In addition to these, supportive measures in postoperative pain treatment after such interventions are also of great importance. As a rule, patients are supported by therapists with breathing therapy and mobilization from the first day after the operation. Furthermore, putting on an elastic waist belt can make coughing up and mobilization much easier. In order to avoid complications and severe pain, more physical work should be started no earlier than 4 weeks after the operation.

Pain after biliary surgery

Pain after biliary surgery is usually treated with drugs of the first WHO level, such as metamizole or ibuprofen. Significantly more complaints than the actual operation scars, however, often cause the consequences of the inflated abdominal cavity during the operation. This inflation is necessary because nowadays interventions on the gall bladder are mainly performed laparoscopically instead of via a conventional abdominal incision. Air is passed into the abdominal cavity so that the surgeons have a sufficient view of the surgical area when using this surgical technique. After completing the operation, most of this air is sucked out again. However, there is always a certain amount of residue, which can subsequently cause the flatulence with pain. In addition to painkillers, exercise, the application of heat, e.g. with a hot water bottle, or various herbs such as chamomile, peppermint, caraway or anise. Means such as simethicone or magnesium preparations can also help against flatulence and the pain associated with it. It is important, as after all operations, to pull the scars, e.g. through thoughtless movements to avoid complications and unnecessary pain.

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Pain after knee surgery

The full restoration of function and mobility is particularly crucial after an operation on the knee joint. In order to achieve this, early mobilization immediately after the operation is essential. Due to the stress on the joint that goes along with it, this also tends to mean more pain. In order to avoid this, a combination of several therapeutic measures has proven successful after surgery on the knee. On the one hand, pain catheters or pumps are often used in the first few days after the operation, through which the permanent administration of opioids is guaranteed. In addition, pain relievers and anti-inflammatory drugs are given in fixed doses as tablets. The pain catheters can usually be removed between three and five days after the operation and the medication is switched to tablets. In addition to the therapy with painkillers, physical exercises and measures such as elevation and cooling also contribute significantly to pain relief and better recovery after the operation.

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Pain after hip surgery

In addition to pain medication in tablet form, dosage forms such as pain pumps or catheters have clearly proven themselves in hip operations. These are mainly used in the phase of the greatest pain immediately after the operation and gradually switched to weaker medication, which can then be taken as tablets, until discharge. The advantage of these pain pumps is that they can be controlled by the patient himself. This enables an exact adjustment to the individual pain perception after the operation. The respective dose that can be given by the patient at the push of a button is set beforehand by the doctor. An additional control mechanism to avoid overdosing is a blocking interval. After reaching a certain dose, no further medication is given in this, even when the button is pressed.

Additional measures to alleviate pain after hip surgery include correct positioning and cooling of the surgical scar. Furthermore, attention should be paid to adequate mobilization, initially under guidance and relief using crutches when walking, as too early or too much stress is a very common cause of increased postoperative pain.

Pain after carpal tunnel surgery

As with all surgical interventions, the optimal therapy for postoperative pain begins before the carpal tunnel operation with the planning of the optimal anesthetic procedure. It has been shown that a regional procedure, a so-called plexus block, is preferable to general anesthesia. On the one hand, this has the advantage that a hospital stay of several days is not necessary, so the operation can be carried out on an outpatient basis. On the other hand, the patients complain of significantly less pain and therefore also need less painkillers in the period after the operation.

In the first two weeks after the operation, the hand is usually immobilized with a splint to ensure good wound healing. However, so that mobility and nerve function are not subsequently restricted, suitable movement exercises should be carried out under supervision from the first day after the procedure. Furthermore, no heavy objects should be lifted or strenuous work should be carried out with the affected hand until about 6 weeks after the operation.

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Pain after an almond operation

Pain after an almond operation is usually treated with drugs of the lowest WHO level. Paracetamol or metamizole are particularly suitable here, as they have no effect on blood coagulation and therefore pose a lower risk of secondary bleeding. In the case of very severe pain, weak opioids can also be used in combination with these. As a rule, however, an attempt is made to keep the opioid requirement as low as possible, since substances of this substance class have significantly more possible side effects.

The supportive measures after an almond operation also have a very positive effect on the healing process. This includes e.g. cooling the throat both internally, e.g. by eating ice cream, as well as from the outside with cool packs. Consumption of soft foods and extensive chewing can also help reduce pain significantly. Sufficient drinking quantities and mouth rinses with sage or chamomile tea also support wound healing and have a positive effect on the postoperative course.

Pain after dental surgery

After a dental operation, pain therapy is usually carried out with drugs of the first WHO level. Ibuprofen or diclofenac are particularly suitable here. In addition to their analgesic effects, these drugs also have anti-inflammatory properties. This is particularly important in dental surgeries, as these are often associated with inflammatory processes in the oral cavity. In the case of very extensive interventions that involve comparatively large tissue damage, opioids can also be used to treat pain in the first few days. However, this should not be done over a long period of time.

In addition to medication, homeopathic remedies can also be used to relieve pain after dental surgery. Frequently used substances are e.g. Calcium phosphoricum or Theridion. A consultation with the doctor should take place before the procedure. Herbs, such as Chamomile can help relieve pain. The cooling from outside and the softest possible food also help to reduce pain.

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