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.

Benefits and Risks of Pain Treatment Methods

This information is provided to help you discuss your options with your doctors and nurses. Sometimes it is best to combine two or more of these treatments or change the treatments slightly to meet your individual needs. Your doctors and nurses will discuss this with you.

Pain Relief Medicines

Nonsteroidal anti-inflammatory drugs:
Acetaminophen (for example, Tylenol), aspirin, ibuprofen (for example, Motrin), and other NSAIDs reduce swelling and soreness and relieve mild to moderate pain.

• Benefits: There is no risk of addiction to these medicines. Depending on how much pain you have, these medicines can lessen or eliminate the need for stronger medicines (for example, morphine or another opioid).
• Risks: Most NSAIDs interfere with blood clotting. They may cause nausea, stomach bleeding, or kidney problems. For severe pain, an opioid usually must be added.

Opioids:
Morphine, codeine, and other opioids are most often used for acute pain, such as short-term pain after surgery.

• Benefits: These medicines are effective for severe pain, and they do not cause bleeding in the stomach or elsewhere. It is rare for a patient to become addicted as a result of taking opioids for postoperative pain.
• Risks: Opioids may cause drowsiness, nausea, constipation,

Local anesthetics:
These drugs (for example, bupivacaine) are given, either near the incision or through a small tube in your back, to block the nerves that transmit pain signals.

• Benefits: Local anesthetics are effective for severe pain. Injections at the incision site block pain from that site. There is little or no risk of drowsiness, constipation, or breathing problems. Local anesthetics reduce the need for opioid use.
• Risks: Repeated injections are needed to maintain pain relief. An overdose of local anesthetic can have serious consequences. Average doses may cause some patients to have weakness in their legs or dizziness.

Methods Used to Give Pain Relief Medicines

Tablet or liquid:
Medicines given by mouth (for example, aspirin, ibuprofen, or opioid medications such as codeine).

• Benefits: Tablets and liquids cause less discomfort than injections into muscle or skin, but they can work just as well. They are inexpensive, simple to give, and easy to use at home.
• Risks: These medicines cannot be used if nothing can be taken by mouth or if you are nauseated or vomiting; sometimes these medicines can be given rectally (suppository form). There may be a delay in pain relief, since you must ask for the medicine and wait for it to be brought to you; also, these medicines take time to wear off.

Injections into skin or muscle:

• Benefits: Medicine given by injection into skin or muscle is effective even if you are nauseated or vomiting; such injections are simple to give.
• Risks: The injection site is usually painful for a short time. Medicines given by injection are more expensive than tablets or liquids and take time to wear off. Pain relief may be delayed while you ask the nurse for medicine and wait for the shot to be drawn up and given.

Injections into vein:
Pain relief medicines are injected into a vein through a small tube, called an intravenous (IV) catheter. The tip of the tube stays in the vein.

• Benefits: Medicines given by injection into a vein are fully absorbed and act quickly. This method is well suited for relief of brief episodes of pain. When a patient controlled analgesia (PCA) pump is used, you can control your own doses of pain medicine.
• Risks: A small tube must be inserted in a vein. If PCA is used, there are extra costs for pumps, supplies, and staff training. You must want to use the pump and learn how and when to give yourself doses of medicine.

Injections into spine:
Medicine is given through a small tube in your back (called an epidural or intrathecal catheter).

• Benefits: This method works well when you have chest surgery or an operation on the lower parts of your body.
• Risks: Staff must be specially trained to place a small tube in the back and to watch for problems that can appear hours after pain medicine is given. Extra cost is involved for staff time and training and to purchase pumps and supplies.

Non-drug Pain Relief Methods
These methods can be effective for mild to moderate pain and to boost the pain-relief effects of drugs. There are no side effects. These techniques are best learned before surgery.

Patient teaching:
Learning about the operation and the pain expected afterwards (for example, when coughing or getting out of bed or a chair).

• Benefits: These techniques can reduce anxiety; they are simple to learn, and no equipment is needed.
• Risks: There are no risks; however, patient attention and cooperation with staff are required.

Relaxation:
Simple techniques, such as abdominal breathing and jaw relaxation, can help to increase your comfort after surgery.

• Benefits: Relaxation techniques are easy to learn, and they can help to reduce anxiety. After instruction, you can use relaxation at any time. No equipment is needed.
• Risks: There are no risks, but you will need instruction from your nurse or doctor.

Physical agents:
Cold packs, massage, rest, and TENS therapy are some of the non-drug pain relief methods that might be used following surgery.

• Benefits: In general, physical agents are safe and have no side effects. TENS, which stands for transcutaneous electrical nerve stimulation, is often helpful; it is quick to act and can be controlled by the patient.
• Risks: There are no risks related to the use of physical techniques for managing pain. If TENS is used, there is some cost and staff time involved for purchasing the machine and instructing patients in its use. Also, there is only limited evidence to support the effectiveness of TENS for pain relief in certain situations.