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PAIN MANAGEMENT AT HOME AFTER SURGERY
Effective pain management at home after spinal surgery is essential for a smooth recovery. Proper medication management, and following the surgeon’s instructions can help alleviate discomfort and promote healing.
Pain Management After Surgery
After your surgery and you are discharged from the hospital, you will be given a prescription for oral pain medicines. The goal of pain management at home is to reduce pain so that you can participate in physical therapy and other daily activities for a faster recovery.
You have a team helping you at the Southwest Scoliosis and Spine Institute and we will provide you with a pain management medication plan. We will provide pain medicines when you are in the hospital and provide a prescription for your pharmacy after your discharge. Also, we will continue to proscribe your pain medicines and move to milder ones as you begin to heal.
Helpful Hints to Reduce Pain
- Stay “ahead of” your pain; take pain medicine before your pain gets out of control or it will be less effective.
- Consider taking your pain medicines at least 30 minutes prior to your physical therapy sessions.
- Apply an ice pack, not directly on the skin, and no longer than 20 minutes per hour — a bag of frozen peas wrapped in a kitchen towel works well.
- Change positions every 45 minutes during the day.
- Avoid prolonged sitting or standing in place.
- DO NOT use a heating pad on your cut area.
Questions and Answers
How long will I experience Pain after Spine Surgery?
The duration of pain after spine surgery varies depending on the specific procedure performed, the individual’s overall health, and the extent of the surgery. It is common to experience some pain in the immediate post-operative period, which can gradually improve over time. In general, most patients will have significant improvement in pain within a few weeks to a few months following surgery.
What Pain Management Techniques are used after Spine Surgery?
Pain management after spine surgery typically involves a multimodal approach, combining different techniques to effectively control pain. This may include medications such as analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, if necessary. Other pain management techniques may include physical therapy, ice or heat therapy, transcutaneous electrical nerve stimulation (TENS), and relaxation techniques. The specific pain management plan will be tailored to the individual’s needs and may vary depending on the type of surgery and the surgeon’s recommendations.
Are their risks when taking medicine for pain after Spine Surgery?
Pain medications used after spine surgery can have potential risks and side effects. Opioids, in particular, carry the risk of dependence, addiction, and respiratory depression. Non-opioid medications like NSAIDs can have adverse effects on the gastrointestinal system or kidneys. It is important for patients to follow their surgeon’s instructions regarding medication dosage and duration and to report any concerning side effects to their healthcare provider. Pain management strategies may also include non-medication approaches to minimize the need for prolonged medication use.
Medications for Pain Management After Surgery
Our doctors will provide prescriptions for you when you leave the hospital. For example, these are pain medications, muscle relaxants, and/or anticonvulsants.
Narcotics
Narcotics are useful in reducing pain and improving the ability to function and/or work. However, narcotics are also very addicting, and long-term use should be avoided. Depending on many variables, your doctor will determine which pain medicine is right for you. Then for the first couple of days at home, the dosage is every four to six hours, and as you heal, less pain medicine will be needed. You can start by increasing the timeline to take doses. After that start reducing the number of pills that you consume each time. In addition, you will feel a certain amount of discomfort until the inflammation and swelling go down. Also, you need to wait for the time till the nerve sensitivity decreases.
Most patients are off all narcotic pain medications for six weeks.
Narcotic side effects may include:
- Constipation
- Drowsiness
- Itchiness
- Nausea and vomiting
- Impaired judgment (do not make important decisions, operate heavy machinery, or do work at elevated heights while on narcotics)
Muscle Relaxants
Post-operative muscle contractions can turn out to be severe and painful. This pain occurs due to muscle retraction and dissection at the time of surgery. Moreover, a combination of muscle relaxants, rest, and stretching helps to manage muscle spasms. Furthermore, muscle relaxers are scheduled to be taken every six to eight hours. DO NOT stop muscle relaxants unless directed to do so as this will increase your pain.
Muscle relaxant side effects may include:
- Flushing
- Dizziness
- Drowsiness
- Metallic taste
- Nausea and vomiting
If you were prescribed Valium in the hospital for muscle spasms, it was as a supplement, not a replacement, for your scheduled muscle relaxant. Do not continue Valium once you leave the hospital because we cannot monitor you closely and those medications can have dangerous medication interactions.
Nerve-Stabilizing Medications (Anticonvulsants)
Patients who have nerve-related leg pain after surgery will be prescribed an anticonvulsant such as:
- Lyrica (pregabalin)
This class of medications decreases the number of pain signals sent out by damaged nerves. They relieve neuropathic pain (nerve pain) that can occur in arms, hands, fingers, legs, feet, or toes. Symptoms should gradually improve over time.
Anticonvulsant side effects may include:
- Drowsiness
- Fatigue or weakness
- Dizziness
- Headache
- Shaking from a part of your body that you cannot control
- Swelling of the extremities
Over-the-Counter Medications
Over-the-counter medications such as acetaminophen (Tylenol) are often used initially to control back pain. They are easily accessible and can help manage mild to moderate pain.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are another common category used for both pain relief and reducing inflammation. Examples include ibuprofen and naproxen, which are available under various brand names like Aleve, Motrin, and Advil.
Steroids
Steroids are sometimes used when there is significant inflammation causing back pain. However, they are used sparingly due to their systemic effects and are generally not recommended for long-term use.
Antidepressants
Certain antidepressants, such as tricyclic antidepressants and medications likeCymbalta, can also be effective for managing chronic pain. They are often used when pain is persistent and not adequately controlled by other medications.
By understanding the different categories of medications available, you and your doctor can work together to find the most effective treatment plan for your specific needs.
Consult Your Medical Professionals
It’s important to discuss your personal medical history and all medications with your surgeon, primary care provider, and/or pharmacist. This ensures you are using the safest and most effective pain relief options during your recovery.
Gradual Weaning Instructions
Your prescription will typically include instructions for how to gradually wean off the medication over a few weeks. If these instructions are not provided, ask your surgeon and/or pharmacist for recommendations.
Time Frame
There is usually no need for opioids after about 2 weeks to 1 month.
Alternative Pain Relief Options
As you transition away from opioid pain medications, consider these alternative options and be aware of their pros and cons:
Acetaminophen (e.g. Tylenol):
- Acetaminophen is considered a relatively safe and effective pain medication and can be used when weaning off opioid pain medications.
- Monitor dosages closely to avoid liver damage. The daily dose should not exceed 4000 milligrams (8 extra strength Tylenol pills).
- People who drink alcohol should be especially careful to understand the potential risks before taking any.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
- Avoid aspirin products and NSAIDs—such as ibuprofen (Advil), naproxen (Aleve), or COX-2 inhibitors (Celebrex)—for at least 3 months after lumbar fusion. These products may interfere with the growth and development of the bone fusion.
- In some situations, these products may be necessary for the treatment of other health conditions.
Consult Your Doctors About Pain Management After Surgery
It’s important to discuss your personal medical history and all medications with your surgeon, primary care provider, and/or pharmacist. This ensures you are using the safest and most effective pain relief options during your recovery.
Most patients are off all narcotic pain medications for six weeks.
Narcotic side effects may include:
- Constipation
- Drowsiness
- Itchiness
- Nausea and vomiting
- Impaired judgment (do not make important decisions, operate heavy machinery, or do work at elevated heights while on narcotics)
- Muscle Relaxants
Post-operative muscle contractions can turn out to be severe and painful. This pain occurs due to muscle retraction and dissection at the time of surgery. Moreover, a combination of muscle relaxants, rest, and stretching helps to manage muscle spasms. Furthermore, muscle relaxers are scheduled to be taken every six to eight hours. DO NOT stop muscle relaxants unless directed to do so as this will increase your pain.
Muscle relaxant side effects may include:
- Flushing
- Dizziness
- Drowsiness
- Metallic taste
- Nausea and vomiting
If you were prescribed Valium in the hospital for muscle spasms, it was as a supplement, not a replacement, for your scheduled muscle relaxant. Do not continue Valium once you leave the hospital because we cannot monitor you closely and those medications can have dangerous medication interactions.
Nerve-Stabilizing Medications (Anticonvulsants)
Patients who have nerve-related leg pain after surgery will be prescribed an anticonvulsant such as:
- Neurontin (gabapentin)
- Lyrica (pregabalin)
This class of medications decreases the number of pain signals sent out by damaged nerves. They relieve neuropathic pain (nerve pain) that can occur in arms, hands, fingers, legs, feet, or toes. Symptoms should gradually improve over time.
Anticonvulsant side effects may include:
- Drowsiness
- Fatigue or weakness
- Dizziness
- Headache
- Shaking from a part of your body that you cannot control
- Swelling of the extremities
Additional Information about Medications & Pain Management After Surgery
IMPORTANT INFORMATION ABOUT OTHER MEDICATIONS, AND DIETARY AND HERBAL SUPPLEMENTS
Just as some medications and dietary and herbal supplements can affect patients during surgery, there are some drugs that can also interfere with recovery and spinal fusion. For instance, NSAIDs (anti-inflammatories) can impede the spinal fusion process. Do not take them or any medications containing them for at least six months after all fusion surgeries. These include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), meloxicam (Mobic), and oxaprozin (Daypro).
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National Institute of Health: Managing Pain after Spine Surgery
If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment.