American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Common Questions

What is safe and effective pain control?

Safe pain control is the use of medication and other therapies to control pain with the least amount of side effects.

Your surgical team will work with you to:1

  • Screen for current opioid use and risk for overuse
  • Use alternatives to opioids whenever possible
  • Educate you about:
    • Using the lowest dose of opioids for the shortest amount of time
    • Safely getting rid of any unused opioids
    • Knowing the signs of opioid overdose

What is the goal of pain control?

The goal of pain control is to:

  • Minimize pain
  • Keep you moving
  • Help you heal

All members of your surgical team (including nurses and pharmacists) are committed to stopping opioid abuse and long-term use following surgery.

What are my options for safe and effective pain control?

Your surgical team will talk with you about your pain control options.

Your pain plan will be based on your:

  • Operation
  • Pain history
  • Current medications

A combination of therapies and medications will be used together for better pain control after your surgery.2

How do I know what to take to feel better?

When you go home, your pain plan may have you start with a combination of non-medication therapies and non-opioid medications.

For complex procedures you may start on a combination that includes opioids. After several days, you may decrease your opioids and use non-medication therapy and non-opioid medications.

9 out of 10 patients report that their pain is either mild or gone four days after surgery.

Pain Management Guide

What are the most common pain control therapies and medications?

Non-Medication Therapies

Mild Pain

Therapy

Description

Self-care

Ice, elevation, and rest

Complementary therapies

Meditation9, guided imagery10, acupuncture11-12, massage13, and music

Rehabilitation therapies

Occupational and physical therapy

Exercise

Stretching, walking, and mild exercise

Non-Opioid, Oral Medications

Mild-to-Moderate Pain

Medication

Common Side Effects*

Acetaminophen (Tylenol®):
Decreases pain and fever

Nausea, vomiting, headache, and insomnia

Liver damage may occur at high doses (greater than 4,000 mg in 24 hours)14-15

Non-steroidal anti-inflammatory drugs (NSAIDs):
Decrease swelling and fever

  • Aspirin
  • Ibuprofen (Advil®16, Motrin®17)
  • Naproxen (Aleve®18)
  • Celecoxib (Celebrex®19)

Upset stomach

Serious risks: Stomach bleeding or ulcers, heart attack, and stroke

Celecoxib has a lower risk of stomach bleeding and/or ulcer formation over the short term19

Nerve pain medications:
Reduce pain from sensitive nerves

  • Gabapentin (Neurontin®20)
  • Pregabalin (Lyrica®21)

Dizziness, drowsiness, suicidal thoughts, swelling in the hands and feet, weight gain, and blurred vision

Risks increase if you have kidney, liver, or heart disease; or have suicidal thoughts

Opioids

Severe Pain

Medication

Common Side Effects

Opioids:

  • Tramadol (Ultram®22)
  • Codeine with acetaminophen (Tylenol #3 or #4)
  • Hydrocodone (Norco®23, Vicodin®24, Lorcet®)
  • Morphine
  • Hydromorphone (Dilaudid®25)
  • Oxycodone (OxyContin®26)
  • Oxycodone with acetaminophen (Percocet®27, Endocet®)

Dizziness, nausea (very common), headache, drowsiness, vomiting, dry mouth, itching, respiratory depression (very slow breathing), and constipation

Stool softeners are always co-prescribed to prevent severe constipation

Serious risks: Prescription opioid risks include misuse, abuse, addiction, overdose (taking too much of the medication), and death from respiratory depression. Your risk of opioid abuse increases the longer you take the medication.28-30

*Side effects reported in 3% or more of the patients in the study sample

Patients in a hospice or palliative care program or in treatment for substance abuse or opioid dependence will have an individualized plan for postoperative pain management.

How can I safely use opioids to manage my severe pain?

Your Surgeon May

Check if you are at a higher risk for opioid misuse. Here are some questions your surgeon may ask:31

  • Do you or a family member have a history of substance abuse or overdose?
  • Are you currently taking an opioid medication?
  • Do you have depression, anxiety, attention deficit disorder, obsessive compulsive disorder, bipolar disorder, or schizophrenia?

Check a required database to see your previous opioid prescription use.

Review your health and other medications.

You Will:

Take the lowest dose possible, for the shortest amount of time. For surgical patients with severe pain, addiction is rare when opioids are used for 5 days or less.2,32

Never take more medication than prescribed. Do not crush pills, which can speed the rate your body absorbs the opioid and cause an overdose.

Unless told by your provider, never take opioids with antihistamines or sleep aids, sedatives or tranquilizers, anti-anxiety medications, muscle relaxers, or another opioid. Combining these medications with opioids increases your risks of side effects.

Never mix alcohol with NSAIDs or opioids.

Call 911 for an opioid overdose. Common signs of opioid overdose are small pupils, trouble breathing, and unconsciousness. You can die from an opioid overdose.

Can I wait to fill my opioid prescription?

Yes, you can wait to see if you have severe pain before filling your opioid prescription.

Talk with your doctor about this choice:

  • You may not need the medications prescribed for opioid-related side effects (anti-nausea medication and laxatives).
  • Be prepared with access to a 24-hour pharmacy in case your pain becomes severe in the middle of the night.
  • Know that your prescription is good up to 7 days after it is issued.
  • Check if you were given a long-acting anesthetic (stops pain at the wound or surgical site). This may help control your pain for several days, and you may need fewer or no opioids.34-35

How do I store and get rid of my leftover opioids?

For the safe storage of opioids:

  • Keep out of reach of children and pets
  • Hide or lock up medication
  • Keep your medication in its original container so you do not take it by mistake
  • Keep track of the location and number of pills in the bottle

Dispose of your opioids as soon as they are no longer needed at a drug take-back program or safe drop site. Find a site. If there is no disposal site near you, mix unused medication with coffee grounds or kitty litter in a plastic bag, and then throw it in the trash.36

Should I worry about becoming addicted to opioids?

Anyone who takes prescription opioids can become addicted. However, addiction is rare when opioids are used for 5 days or less.32

Opioids block pain and give a feeling of euphoria (feel high).39 Taking prescription drugs to get high is sometimes called prescription drug abuse. The most serious form of abuse is addiction.39 Addiction involves seeking out the drug despite negative effects on your health, family, and work.

You may also develop tolerance, meaning that over time you might need higher doses to relieve your pain. This puts you at higher risk for an overdose.40

You can also develop physical dependence, meaning you have withdrawal symptoms when the medication is stopped suddenly.40 Withdrawal symptoms can include insomnia, anxiety, racing heartbeat, and headaches. Withdrawal symptoms can be managed with medication and by gradually decreasing (tapering) your opioid dose.

For questions and resources to help you or a loved one cope with a substance abuse disorder, visit the Substance Abuse and Mental Health Services Administration website or call the 24-hour hotline at 1-800-662-HELP (4357).

References