Post-Surgical Pain

Pain is described as an unpleasant sensory and emotional experience, it is also highly subjective as each individual learns the application of the word through their own unique experiences.

Pain is a multi-dimensional feeling, and understanding exactly how the body processes sensations of pain remains a complex field, one which is still not yet fully understood. However, the concept of pain is universal and awareness of pain begins at a very young age, even in everyday language adjectives such as burning, stabbing, shooting, sharp, ache, dull ache etc. are all commonly used in an attempt to describe pain.

There are many different types of pain, acute tissue pain is described as being very different from pain felt from cancer for example, neurological pain differs from mechanical pain, some patients suffer chronic pain yet a clear clinical diagnosis cannot be identified – as in the case of fibromyalgia, the symptoms felt however, are no less distressful than in the case of someone with a clear diagnosis. Phantom limb pain is another poorly understood painful disorder and is commonly cited following amputation, whereby the patient feels as though the amputated limb is still present and reports painful sensations. Emotional trauma is also frequently described as being literally painful, and it is widely accepted that the relationship between physical pain and psychological wellbeing is of an extremely complex nature. The subject of pain management is therefore a vast topic, covering an extremely wide range of disorders and differing sensations of pain.

Why Do We Feel Pain?

Pain typically serves as a warning system to the body, an integral part of the body’s defence system, sensations of pain alert us to tissue damage, motivating avoidance behaviour and compelling us to seek treatment if and where possible. The primary sensation of pain is an immediate feeling of unpleasantness, which instantly grabs our attention and prompts us to identify the what and where of the pain, this is typically followed by a secondary stage involving the cognitive processing of the unpleasant sensations – anxiety and distress often occur as a result of intervening thoughts of possible concern for the future. Cognitive responses to pain may vary considerably from individual to individual, depending on a variety of factors, including any pain related past experiences previously suffered, uncertainty regarding the threat to the present state of one’s body, as well as any possible threat to future wellbeing, this process as a whole, all forms part of the unpleasant sensory and emotional experience of pain.

Post-Surgical Pain

Acute Post-Surgical Pain

It is a generally accepted view, that following surgery, most patients expect to feel some form of pain whilst the body recovers. Although surgery is performed for good purposes, any type of surgical incision and internal interference, is none the less an injury to the body, from which it must recover. Sensations of pain felt immediately after surgery are known as acute post-surgical pain and may range from mild to severe, although there are many measures in place to try and minimise the negative feelings of pain and discomfort following surgery, acute post-surgical pain can vary considerably depending on a number of factors.  The type of surgery in itself can be a predictor of the magnitude of acute post-surgical pain, keyhole surgery as opposed to open surgery for example, the size and site of the incision (upper abdominal and chest surgery is often described as more painful post operation), the duration of the surgery, the overall management of the surgery, administration of anaesthesia and post-operative pain relief medication; factors which may affect acute post-surgical pain include any previous negative surgical experiences the patient may have had, as well as their current state of mental health, amongst others.

Individual levels of pain tolerance vary from person to person – high levels of anxiety, depression, emotional stress, sleep related issues can all lower tolerance towards pain. When sensations of post-surgical pain are deemed intolerable by the patient, recovery rate can be severely delayed and a number of other possible complications may arise as a result.

Chronic Post-Surgical Pain

Following surgery, acute pain should not last longer than a few days – however in some cases, it can persist, transitioning into chronic post-surgical pain. Chronic post-surgical pain is defined as post-operative pain which lasts at least 2 months following surgery and any infectious causes of the painful symptoms, have been excluded.

Why Does Chronic Post-Surgical Pain Develop?

It is not always clear exactly why chronic post-surgical pain develops, although there are a number of possible explanations. There appears to be a strong link between severe acute post-operative pain and the subsequent development of chronic pain; injury caused to the body during surgery can be responsible for initiating changes to the nervous system, this may be a result of inadequate control of nociceptors (specialised peripheral sensory neurons which alert the body to potentially damaging stimuli) during and post-surgery.

Damage to the nerves clearly has a significant influence on the development of chronic post surgical pain, however in some cases nerve damage may be an unavoidable consequence of the surgery itself, this can occur during mastectomy for example – chronic pain following mastectomy is referred to as post-mastectomy pain syndrome (PMPS) and is associated with nerve fibre damage.

There are several other possible preoperative risk factors which may contribute towards the development of chronic post-surgical pain, preoperative anxiety is one such factor – a patient having suffered poor post-operative pain relief may have increased levels of anxiety towards other surgeries, this and any other type of psychological vulnerability can be a possible precursor to the development of chronic post-surgical pain. Anxiety and pain often overlap following surgery and such patients may benefit from additional psychological support.

Age, gender, socio-economic state and genetics may also play a role. Some clinicians believe that particular conditions such as fibromyalgia, IBS, chronic headache syndromes as examples, are markers of predisposition for chronic post-surgical pain

Early identification and intervention of such factors can be helpful in providing the appropriate patient care, both pre and post-surgery.

Chronic Post-Surgical Pain Treatment

The Pain Management Clinic

Patients suffering from chronic post-surgical pain are usually referred to the pain management clinic. Specialist pain medicine training in the UK is currently undertaken by anaesthetists and involves unique and highly specialised training. Pain clinicians often use the biopsychosocial model to understand chronic pain, this describes the causes of chronic pain in terms of combined signs and symptoms with biological, psychological and social interactions.

As pain is a highly subjective sensation, any treatment plan for chronic post-surgical pain is individualised and will take into consideration the details of the surgical procedure and post-surgical management, the patient’s medical history, psychological and socio-economic state, as well as any other relevant information. Treatment may involve a combination of pharmacological (medication e.g. paracetamol), physical (e.g. physiotherapy) and psychological (some form of emotional support or therapy).

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment