WHAT IS ACUTE PAIN?
Acute pain is pain which lasts for a short period (few days to few weeks) . It is usually the result of injury to the body for example a skin wound, a broken bone, or a surgical operation.
HOW MUCH PAIN WILL I FEEL AFTER MY OPERATION?
Very minimal if at all. It depends on: –
|1. Your personal pain threshold:
||Some patients have higher thresholds and feel less pain. You can let your anaesthetist know of your personal pain threshold based on your previous experience with injuries or operations.
|2. The type of operation:
||This will not only affect how much pain you feel, but also how long you feel that pain. Your anaesthetist will speak to you regarding pain management options for your operation before your surgery.
HOW WILL YOU KNOW HOW MUCH PAIN I AM FEELING?
Your nurses and doctors will assess the amount of pain you are feeling in a few standardized ways –
- By asking you to grade your pain on a scale of 0 – 10, with 0 representing no pain and 10 representing the worst pain you have ever felt. if you find this very difficult, they may also ask you to grade your pain according to whether it is mild, moderate, or severe.
- By looking at your heart rate, blood pressure, and breathing rate.
- By observing how well you are able to take deep breaths, cough, and move around. This may include asking you to move the affected body part, sit up in bed, or even walk around. your nurses and doctors are trained to assist you during this assessment so as to minimize the amount of pain or discomfort that you feel
HOW MUCH DO I HAVE TO PAY FOR PAIN MANAGEMENT?
It varies with the option chosen. Our costs are very competitive and include not just the equipment and the the medication used, but also the visits that our nurse and anaesthetist will make after your operation to ensure your pain is well managed. Your anaesthetist will be more than happy to discuss the cost of various techniques.
WHY SHOULD I BE TREATED FOR ACUTE PAIN?
Most patients want to avoid pain if possible, and we want to treat it as well as we can.
Untreated acute pain often leads to anxiety, insomnia, and sometimes even a total loss of function. Research also shows that pain has many other less obvious undesirable consequences, such as increasing the risk of irregular heartbeat, heart attack, breathing difficulty, poor intestinal movement, decreased immunity, and an excessive tendency for blood to clot. All these may lead to complications, increased hospital stay, and even death.
HOW WILL I BE TREATED FOR ACUTE PAIN?
All patients will receive painkillers before and throughout the operation. Post-operative pain management options are:
- Swallowed painkillers like panadol, non steroidal anti-inflammatory drugs (NSAIDs) such as brufen, ponstan, synflex, voltaren, arcoxia, or celebrex and opioids such as tramadol and oxycodone. Side effects are rare, and the benefits of decreased pain far outweigh the side effects of painkillers.
||drug allergy, liver impairment, and kidney impairment.
||drug allergy, aggravation of asthma, gastritis, liver impairment, and kidney impairment.
||drowsiness, nausea, vomiting, constipation, and itching.
- Injected painkillers like opioids such as tramadol, fentanyl, morphine, or oxycodone, and an injectable type ofNSAID called toradol.
- Patient controlled analgesia (PCA) – where a pump containing an opioid is connected to your iv cannula. This delivers a fixed dose of medication when pressed. It allows you to control the amount of painkiller you receive, and therefore control the amount of pain you feel. There is a lockout built in so you cannot overdose yourself.
- Spinal – where a very fine needle is inserted into the spinal canal. Local anaesthetic is injected through the needle and acts on the spinal nerves to produce loss of pain sensation and strength in the lower half of the body. Usually used for operations on the lower half of the body. Side effects are uncommon and include headache, bleeding at the injection site, and nerve injury. The risk of paralysis is extremely rare.
- Epidural - where a needle is inserted into the epidural space just around the spinal canal. Local anaesthetic may be injected through the needle, or a thin tube may be placed in the space, after which local anaesthetic is injected through it. The epidural works in almost the same way as the spinal. Side effects are also similar to those for the spinal option.
- Nerve block –where a needle is inserted into the space around the nerve that supplies the part of the body to be operated on; can be the arm, the leg, or even the abdomen. Ultrasound guidance is often used to ensure that the needle is in the right location. Nerve stimulation may also be used to confirm that the needle is in the right location. You may feel painless twitches of your muscles during the nerve stimulation. Local anaesthetic is injected through the needle and acts on the nerve to produce loss of pain sensation and strength in the affected body part. Side effects are uncommon and include bleeding at the injection site, injury to surrounding structures, and nerve injury. The risk of paralysis (like the spinal option) is extremely rare.
WHAT IF I DON’T LIKE SWALLOWING TABLETS?
Besides tablets, swallowed painkillers also come in liquid form, which may be easier for you.
WHAT IF I DON’T LIKE INJECTIONS?
A plastic tube called an iv cannula is usually painlessly inserted into your hand before the operation. most injected painkillers are then given through this cannula with minimal discomfort.
Pain management options like the spinal, epidural, and nerve block usually require an additional injection before the operation, for safety reasons. your anaesthetist will usually give you painkillers and medication to help you relax before the additional injection is performed.
PANADOL? I CAN GET IT OVER THE COUNTER AND CHEAP! WHY DO I HAVE TO TAKE IT AFTER AN OPERATION?
Panadol is widely available and cheap. However, research also shows that it is an effective painkiller when taken in combination with other stronger painkillers. In our experience, we find that prescribing panadol together with other stronger painkillers is often very effective in treating mild to moderate pain often reducing the amount of stronger medication needed.
WHY AM I BEING GIVEN SO MANY DIFFERENT PAINKILLERS AT ONE TIME?
You are probably being treated for moderate to severe pain. Research has shown that painkillers are more effective and have less side effects when combined with other painkillers
I DON’T LIKE OPIOIDS. I THINK I WILL GET ADDICTED TO THEM.
Though opioids can be addictive, there is no evidence that using opioids to treat acute pain leads to addiction. You will be reviewed frequently by your doctors if you are on opioids, and the opioids will be stopped when you no longer require them. There is therefore minimal risk of addiction.
I HAVE MOTION SICKNESS AND PREVIOUS BAD EXPERIENCES WITH OPIOIDS.
Please inform your anaesthetist of the above. Your experience may be due to a particular opioid, in which case a different opioid may be substituted with satisfactory results. or a repeat of your bad experience may be avoided by prescribing prophylactic (preventive) medication together with the opioid.
WHAT IF IM ALLERGIC TO PAINKILLERS?
As can be seen above, there are many pain management options available. It is extremely rare that a patient is allergic to all the painkillers that we have available.
WHAT IF I SUFFER FROM SIDE EFFECTS OF THE PAINKILLERS?
You will be reviewed regularly by your surgeon, by the pain nurse and anaesthetist. They will assess whether your symptoms are due to the painkillers and advise you accordingly.
WHAT IF I SUFFER FROM COMPLICATIONS OF THE PAIN MANAGEMENT OPTIONS?
The risk of complications from your chosen pain management option is usually very low. Even so, you will be reviewed regularly by your pain nurse and anaesthetist. In the unlikely event that complications occur, your pain nurse and anaesthetist will give you the best possible treatment to minimize your chance of a permanent injury.
I AM NOT FEELING ANY PAIN NOW. WHY SHOULD I TAKE THE MEDICATION?
It is likely that if you stop taking the medications you will start feeling pain. Most patients would rather not feel any pain at all, than to feel pain before starting painkillers. Besides, they also work to reduce inflammation and swelling, contributing to a faster recovery from surgery.
WHAT IF MY TREATMENT DOES NOT WORK?
It is very rare that the pain management option you have chosen does not work. If it does not, your anaesthetist will work extra hard to ensure that you suffer minimal pain and discomfort and that the cause of failure is addressed and/ or a new alternative is offered
HOW OFTEN WILL I BE SEEN?
You will be seen daily by the Acute Pain Service team. They will ensure that your pain continues to be well managed and that any side effects or complications are picked up and addressed in a timely manner.
WHAT IF I NEED TREATMENT AT 9PM? WILL THERE ALSO BE SOMEONE TO TREAT MY PAIN AT 2AM IN THE MORNING?
There is 24 hour ward coverage provided by the anaesthetist on duty. Your nurse or doctor knows when to refer issues regarding your pain management option to the anaesthetist on duty.
WHAT IF MY PAIN LASTS MUCH LONGER THAN EXPECTED?
In some instances, acute pain may become chronic pain. It is important, then, to find out the source of the pain, and why it is lasting for so long.Your doctor will contact the anaesthetist on duty for advice and everything will be done to minimize the pain and suffering you have to endure.