Advice on pain relief after surgery
Date issued: August 2021
For review: August 2023
Ref: c-365/RM/REI/Pain relief after surgery v3
PDF: Advice on pain relief after surgery [pdf] 174KB
Good pain relief is important for your well-being; it alleviates suffering and helps you recover quicker from surgery. You will have received a local anaesthetic for your surgery. This means you may have little to no pain at all before you leave hospital. When thinking about your pain, try to decide whether it is MILD, MODERATE or SEVERE when you move your hand.
Pain relief medicines (“pain killers”) come in several forms. Capsules, tablets and liquids may be used for all types of pain. They take about 20-30 minutes to work and should be taken regularly. You need to be able to eat, drink and not feel sick for these drugs to work. The usual pain relief that can be suggested or prescribed after surgery come in 3 categories;
1) Paracetamol.
2) Non-Steroidal Anti-Inflammatory Drugs (NSAID), Ibuprofen & Naproxen.
3) Opioids: Weak opioids, Codeine.
Intermediate opioids, Tramadol.
Strong opioids, Morphine Oral Solution (MOS).
Depending on your surgery it may be suggested that you use more than one type of pain relief. *YOU ARE UNLIKELY TO BE PRESCRIBED/SUGGESTED THAT YOU TAKE OPIOIDS FOR EYE SURGERY*, unless this is your usual pain relief, then carry on as normal.
It is safe to take more than one type, provided they come from different categories (1-3 above). In fact, it is best to take combinations of pain relief that work in different ways - this helps to control your pain whilst minimising side effects. For example: ibuprofen every 8 hours and paracetamol every 6 hours.
Paracetamol
Although Paracetamol is a common ‘over the counter’ pain relief it works well on post-operative pain. Paracetamol is best taken every six hours and two tablets (2 X 500mg) at a time, but NO MORE THAN 4 grams (8 tablets) in 24 hours. We would advise taking Paracetamol regularly for at least the first two days after surgery, irrespective of the level of pain you are experiencing. Paracetamol can safely be taken alongside other pain relief and can help improve their effectiveness.
Non-Steroidal Anti-Inflammatory Drugs (NSAID)
Ibuprofen & Naproxen belong to a type of drug called NSAIDs and work by reducing inflammation (swelling) and pain after surgery. These drugs should be taken with food to reduce the risk of stomach complications.
Ibuprofen can be taken 8hourly (approximately 3 times a day) in 200-400mg (1-2 tablets) doses.
Naproxen is a longer acting NSAID and is prescribed twice a day; in the morning at breakfast, and before bed in the evening (roughly 12 hours apart).
Ibuprofen OR Naproxen taken alongside Paracetamol works very well for MILD or MODERATE pain.
Suggested drug timings for mild, moderate pain:
2 x 200mg Ibuprofen three times a day (breakfast, lunch, evening). WITH FOOD
PLUS
2x500mg Paracetamol four times a day (breakfast, lunch, evening, bedtime).
Opioids
Codeine is a weak opioid and works on MODERATE pain. It works well for some people but not others. It can cause constipation, so regular fluid and fibre intake is important, alongside a short course of Sennakot is advisable. Co-Codamol is a combination of Paracetamol AND Codeine and can be very effective for MILD to MODERATE pain
The combination of paracetamol, NSAID and codeine is very effective in controlling post-operative pain as they all work on different types of pain; bone, muscle, nerve.
Tramadol and Morphine Oral Solution (MOS) are “stronger” opioids and may also be prescribed (by your GP) alongside Paracetamol and NSAID on occasion.
Tramadol is a tablet that is usually taken 4 times a day if needed, in a dose of 50-100mg.
*Overdose can be very dangerous, so it is important to follow the prescribed doses carefully*
Side Effects
There will be an information leaflet from the manufacturer, specific to that medicine, inside each box of pain relief (analgesics) that are suggested to you (or previously prescribed to you).
It will outline the possible side effects that each medicine may cause. Read these information leaflets alongside the advice provided here
When do I start taking my pain relief?
It is advisable to take analgesia BEFORE the anaesthetic wears off to get the best therapeutic effect. As soon as you get any tingling, scratchy, bruising sensation in or around your eye, take some pain relief. Do not wait to be in pain before taking anything as you will then be paying “catch up”, which is not good
When do I stop taking my painkillers?
After 3-5 days you should be able to reduce any new pain relief that was suggested to you post-surgery. If your pain remains well controlled, then you should be able to continue to reduce your painkillers over the next few days.
However, if your pain increases when you reduce / stop the analgesics then it is best to start that pain relief again. If this happens, you could talk to a pharmacist for advice. Your GP or emergency department may help if your pain continues to be severe.
How often do I take my pain relief?
Please follow the instruction label on the boxes of pain relief provided.
How long do they take to work?
All pain relief take at least 20-30minutes to start to work, but up to one hour for the full effect.
Other Points to Remember
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It is important to follow the labels on your medicines, and NOT to exceed the recommended dose. If you are taking cold / flu remedies these may also contain paracetamol, so please check the label and do not exceed 4 grams of paracetamol in 24 hours. If you think that you have taken more than this (in a single dose or in a 24 hour period), please contact your GP or local A&E. Paracetamol overdose can be dangerous.
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Some pain relief needs to be taken with food, so again, please read the manufacturers instructions.
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The App/Website www.headspace.com gives advice on Mindfulness and coping strategies for pain.
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Useful advice on Opioids can be found on the RCOA FPM website, under the sections “Taking Opioids for Pain” & “Thinking About Opioid Treatment for Pain”.
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Lastly remember that MILD PAIN IS ACCEPTABLE.
