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Pain Relief After your Operation

Pain Relief

Definition:

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with the actual or potential tissue damage, or described in terms of such damage or both”.
Pain relief is probably one of the most important factors relating to your operation. If you are in pain before your operation you will be expecting relief immediately afterwards but sometimes this isn’t the case the operation itself may cause pain which you hadn’t expected.

Pain Relief:

Different pain relief is available in many different forms and when you discuss this with your anaesthetist they will advise you of which forms they believe will offer you the best results. This conversation is extremely important for you as you will then feel confident that you will not be left in pain at any time, anxiety about pain increases the amount of pain which people feel.

Pain relief can be:
            Increased
            Given more regularly
            Given in different combinations

Good pain relief = Good practise

The aim is to relieve your pain - if you are able to move without pain you are less likely to develop a blood clot, also you are less likely to develop a chest infection as you will be able to cough.

The Health Care Commission which was set up in 2004 to promote quality in the private and public sector, carried out an audit 73% of people questioned felt that their pain had be managed well- with staff doing all they could to relieve it.

There are three types of pain:

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Acute pain:


Acute is the term applied when the attack is sudden, severe and of short duration. This is caused by:

  • Surgery
  • Injury or trauma
  • Illness
  • Painful medical procedures

Once the cause has been treated or healed the pain disappears.

Chronic pain:

Chronic is the term applied when a condition is ongoing and of a long duration. The intensity of chronic pain can range from mild to severe causing quality of life issues. The pain may well have resulted from an initial injury resulting in the pain becoming an ongoing problem. This can lead to long term stays in hospital and repeated outpatient appointments.
Chronic pain complaints often include

  • Lower back
  • Cancer
  • Arthritis
  • Neurogenic – this is pain resulting from damage to nerves or to the central nervous system
  • Psychogenic – this pain is not due to past disease or injury or any visible sign of damage
  • Migraines and Headaches
  • Angina
  • Pelvic

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Malignant Pain:


This pain is associated with diseases like cancer –the pain is caused by the tumour affecting the surrounding tissues, most commonly bone tumours. The pain needs to be carefully assessed and appropriately treated.

Pain Teams:

Most hospitals have pain clinics which have Anaesthetic Consultants who specialise in pain relief; often these are supported by nursing staff that specialise in pain relief as well. The nurses will visit you regularly on the wards to ensure you are comfortable and that your pain is being well managed, you may ask to see one of the team at any time.

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Pain scales:

Pain scales are a really useful tool for you to use they help you to assess your pain. They are also useful for the people who are treating you; to be able to treat it appropriately with the correct types of pain relief medicines. Pain intensity can vary between mild, moderate, or severe pain.

Pain score cards can be used as visual prompts like smilie faces which change depending on the level of pain- especially good for children.

  • For adults a scale of 1-10.
    1= no pain and 10 = the most excruciating pain

It is much easier to relieve pain if it is dealt with before it gets bad, ask for help as soon as you feel pain, the treatment for pain needs to be regular for it to be effective.

The British pain society  www.britishpainsociety.org have developed a pain scoring standard which can be downloaded in many different languages to help with the description and management of pain.

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Types of pain relief:

 

See Also:

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Tablets and Liquids
:
The most common mild to moderate pain relief tablets are:

  • Aspirin – active within 20-30 mins lasts for approx 4hrs.- for pain and inflammation - Aspirin has an association with Reye's syndrome and should not be used to provide analgesia in children under the age of 12 years.
  • Paracetamol - active within 20-30 mins lasts for approx 4hrs.-for pain not inflammation
  • Non-steroidal anti-inflammatory drugs (NSAIDs) - for pain and inflammation. They are useful for superficial pain arising from the skin, mouth mucosa, joint surfaces and bone. - Care should be taken when using these medicines if you have asthma or impaired renal function.

Benefits:

Aspirin, Ibuprofen or Paracetamol can be taken by mouth. Tablets and liquids cause less discomfort than injections into a muscle or the skin. They are easy for you to take when you go home from the hospital.

Drawbacks:

These medicines can't be used if you aren't supposed to take anything by mouth or if you're nauseated or vomiting. However some of these medicines come in a rectal suppository, so you can take them even if you're feeling sick.

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Injection
:

Systemic (This means it has an effect on the whole body) or local

  • Intramuscular- into the muscle /upper thigh /upper arm/ buttock
  • Intravenous – into vein drugs act more rapidly
  • Subcutaneous –  under the surface of the skin

Injected medicines given into muscle can take from 20minutes to half an hour to work
The most common pain relief for severe pain are in the opioid group

  • Morphine –used for short term acute pain after your operation

Benefits:

Opioids work well for severe pain. They don't cause bleeding in the stomach or other parts of the body. Medicines given as injections can work even if you're nauseated or vomiting.

Drawbacks:

Opioids may cause drowsiness, sickness, constipation or itching. They can also interfere with breathing and you may have difficulty passing urine. The injection site usually hurts for a short time afterwards.

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Patient-controlled analgesia (PCA)
:

This is an excellent device which has been designed so you are able to administer pain relief when you need it. The pump has a controlled amount of an opioid which you are not able to overdose on. Every time you press the button, a dose is administer via the cannula (a small plastic tube) which is in you vein, the doctors will have calculated how much you may require. You will be shown how to use it before your operation

Benefits:

Because it is in the vein the medicine works faster than either tablets or intramuscular injection.  You do not have to keep asking staff for pain relief and have to wait for them to get it for you it is immediate.  

Drawbacks :

Where you go the pump needs to go. Same drawbacks as opioids.

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Suppositories
:

These are waxy bullet shaped capsules that are placed in your back passage (rectum). The capsule dissolves and the drug is absorbed easily by your body.

Benefits
:

They are useful if you cannot swallow or if you are likely to vomit. They are often used to supplement to other pain relief methods.

Drawbacks:

We here in Britain are not great fans of suppositories as a form of taking medicines whereas elsewhere in the world this is quite common.

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