Description of the pain

There are different types of pain and their treatment is different. For this reason, the more precisely the pain is described, the better the postoperative pain therapy. For this purpose, the exact location must be stated and the so-called pain quality, the type of pain, must be described.

For example, pain can be characterized as stabbing, drilling, dull or burning. The intensity of the pain is also an important factor. In many clinics, this is checked daily by the nursing staff using a scale of 0-10.

Here, 0 means freedom from pain, while 10 means the strongest pain imaginable. Also relevant for postoperative pain therapy is whether the pain is always present or recurs regularly and also whether and by which factors the pain can be increased or alleviated. In order to get an idea of the healing process, the course of the pain is also important for the doctor.

It should be observed whether the pain improves or worsens, whether the character changes and also whether the location of the pain shifts. The treatment of pain arising in connection with a surgical procedure (postoperative pain) is called “postoperative pain therapy” in medical terminology. Postoperative pain is usually treated by the administration of pain-relieving medication.

In this context, there is a strict step-by-step plan that determines both the type and the dosage of the possible drugs. Although intravenous (via the vein) drugs usually work much faster and more effectively in most cases, oral administration of painkillers (taking tablets or drops) should be preferred. In patients who only have slight postoperative pain, the treating physician usually starts to administer so-called non-opioid analgesics.

These are comparatively weak analgesics such as paracetamol, ibuprofen or novalgin. These drugs exert their effect by inhibiting the so-called cyclooxygenases. These are enzymes that are involved in the release of pain mediators, among other things.

Active ingredients from the group of non-opioid analgesics can be used in combination with opioids if required. Opioids are strong painkillers that contain morphine-like substances and are many times more effective than drugs from the group of non-opioid analgesics. However, after particularly large operations, postoperative pain is often so severe that oral administration of painkillers no longer provides sufficient relief.

In these cases, the systemic administration of opioids is an important part of postoperative pain management. Opioid analgesics release their effect directly at the central nervous system by specifically blocking the switching points of the nerve cells and thus suppressing the transmission of pain information. Due to their mechanism of action, however, the administration of these drugs can lead to severe side effects.

The most common side effects of opioids in the treatment of post-operative pain include influencing breathing (respiratory depression), triggering nausea, constipation and urinary retention. In most cases, the patient suffering from postoperative pain is given a catheter close to the spinal cord (so-called “peridural catheter”).Through this access, local anesthetics used to alleviate postoperative pain can be placed directly near the spinal cord. For most methods of postoperative pain therapy, the exact, patient-specific dosage still poses an enormous problem.

In most cases, outsiders (relatives, physicians or nursing staff) are unable to estimate how pronounced and intense the postoperative pain felt by the patient actually is. Even the common pain scales can only give an indication. In addition, the necessary consultation between physician and nursing staff before the application of painkillers represents an unnecessary delay in pain therapy.

For this reason, the so-called “patient-controlled analgesia (short: PCA)” is now considered the most effective method in the therapy of postoperative pain. The term “patient-controlled analgesia” refers to a principle whereby the individual patient is able to determine the dosage and application intervals of the analgesic selected by the physician independently. This method makes it possible to reduce the time between the need for medication and the actual intake of medication from about one hour to only a few minutes.

Post-operative pain is therefore absorbed in the course of patient-controlled analgesia as soon as it occurs, thus significantly improving the patient’s well-being. In addition, the patient can be given a feeling of autonomy and independence. In most cases, Patient-Controlled Analgesia is performed via a catheter close to the spinal cord.

The patient suffering from post-operative pain can regulate the required analgesic dose by pressing a button. This allows a targeted dose adjustment to different intensities of postoperative pain. The patient is thus able to adapt the drug administration to different situations.

If, for example, mobilization, repositioning or physiotherapy is required, which usually leads to an increase in postoperative pain, a higher dose can be administered before the onset of pain. In addition, a dose bolus (i.e. a basic quantity of painkillers) is administered at regular intervals via the catheter. This method also eliminates the risk of overdosing the analgesic, because the pain pump attached to the spinal cord catheter is programmed in such a way that a maximum dose cannot be exceeded.

If the contraindications of patient-controlled analgesia are strictly adhered to, this method offers a number of advantages over the usual basic therapy of postoperative pain. Above all, the satisfaction and well-being of the individual patient can be significantly increased by the long pain-free intervals. Ultimately, this also has an effect on the patient’s psyche.

In addition, the patients’ fears of severe postoperative pain can be relieved. The WHO recommends a step-by-step approach to pain therapy. The basis of every postoperative pain therapy is medication from the group of non-steroidal anti-rheumatic drugs, including known drugs such as ibuprofen or paracetamol.

They are usually administered as tablets, juices or suppositories. In order to achieve lasting pain relief, it is necessary that the drug is always present in the blood in sufficient dosage. There are therefore fixed dosages and times at which the medication should be taken.

Decongestant drugs such as bromelain, which can be purchased under the name Wobenzym®, for example, are also supposed to support healing and postoperative pain. For patients with mild to moderate pain, treatment with this type of painkiller alone is often sufficient. Within the framework of basic drug therapy, regular recording of the pain level is of great importance in order to be able to adjust the pain therapy if necessary.

If stronger pain occurs occasionally, for example during physiotherapy, the postoperative pain therapy can be supplemented by an additional stronger medication, which is taken as needed. Drugs from the group of weakly effective opiates, which represent the second stage of the WHO pain scheme and are given in combination with the painkillers of the first stage, are suitable for this purpose. These include, for example, the drug tramadol.If a surgical procedure is associated with very severe pain, a strong opiate is administered in addition to the non-steroidal anti-inflammatory drugs (stage 1), such as the drug Dipidolor.

Opiates act where the sensation of pain occurs: in the central nervous system. Typical side effects are nausea, constipation and fatigue. They can lead to restricted breathing and are generally capable of causing dependence. For this reason opiates are feared by many patients, but this is unfounded as long as these drugs are taken as prescribed by the doctor.