Non-drug therapies can help to relieve pain in hospital patients after surgery, a new study suggests. The study included 1,837 patients who had surgery at a hospital. They were given various treatments for pain. The treatments included acupuncture, acupressure, massage, music or aroma therapy, reflexology, healing touch and therapies to help them relax. They were asked to score their pain before and after treatment. The score range was 0 to 10. Researchers said the non-drug treatments reduced pain by up to half in some people. The study appeared March 5 in the Journal of Patient Safety.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
If you've ever had surgery, you might remember this: It hurt.
Usually it helps to give medicines after surgery to prevent and treat pain. But pain medicines can cause problems. Nausea, constipation and confusion are among the most common side effects. They can also cause more serious problems. For example, narcotics, such as morphine, can suppress breathing.
It's a major challenge to control pain after surgery without causing side effects. This is especially true for the elderly. They often have multiple medical problems and already take several other drugs.
That's why the results of a new study of non-drug treatments for pain after surgery are so interesting. Results appear in the latest issue of the Journal of Patient Safety.
Researchers enrolled more than 1,800 patients who had just had surgery. Each person reported pain on a scale of 0 to 10. Treatment included "alternative" approaches such as:
- Acupuncture
- Massage
- Aromatherapy
- Meditation
- Music therapy
The results surprised me. Pain scores fell by as much as 50% after these treatments.
These findings suggest that non-drug treatments might be an overlooked source of pain relief after surgery. These treatments might allow many people to require less pain medicine -- or even none -- after an operation.
Non-drug treatments have several potential advantages. They include:
- Reducing or avoiding medicine side effects
- Making pain less severe or likely to go away sooner
- Reducing the amount of time in the hospital after surgery (including the extra time required to treat drug side effects)
- Reducing the costs of care after surgery
- Giving a more acceptable option to people who may prefer to avoid powerful pain killers, such as morphine
How can treatments such as massage or music therapy control pain after surgery? That's not clear, but the placebo effect is one possible explanation. This means that expecting to feel better may somehow "trick" the brain into feeling less pain even though the treatment has no direct biological effect on pain. I'm not sure it matters so much how it works. If non-drug treatments can lead to safe and reliable pain relief after surgery, we should offer them routinely.
What Changes Can I Make Now?
If you plan to have surgery, talk to your doctors about pain control after the operation. Knowing as much as you can about what to expect can be helpful. If you are interested in relaxation or meditation techniques, practice before your operation.
Keep in mind that pain control after surgery can help to speed your recovery. For example, pain that prevents you from coughing or from taking a deep breath may increase your risk of pneumonia.
Here are some other measures you can take to help with pain after surgery:
- Let your doctors know about what has happened after previous surgeries, including any problems with pain control.
- Tell your doctors about any medicine allergies you have and any pain medicines you've been taking before surgery.
- Tell your nurse and doctor about your pain. Pain tends to be easier to control if treated early. So don't wait until it's severe to say something.
- If the pain is still bad despite treatment, tell your nurse or doctor. An increased dose or a new medicine may help more.
- Find out whether your pain treatment will be provided at certain times or whether you have to ask for it.
- Ask about non-drug options. As noted in this latest research, you may get a lot out of treatments such as massage or acupuncture if these are available.
- Ask about a "patient-controlled analgesia" (PCA) pump. This device delivers pain medicine into your vein when you push a button. This gives you control over pain treatment. With a PCA pump, you don't have to wait for your nurse to bring a pill. You also don't have the discomfort of having a shot (injection). It also tends to be a safe option because the settings prevent you from getting too much medicine.
- Make sure you know what pain medicine and other treatments to use once you are back home. Fill any prescriptions promptly so you will have what you need in case pain continues.
- Ask about activities you should avoid at home. For example, it may be important to avoid lifting heavy objects after surgery. Also, you should not drive if you are taking certain pain relievers.
The good news in pain control after surgery is that treatments have improved a lot in recent years. I believe health care professionals pay more attention to pain now than in the past. And considering all of the options available, pain after surgery can almost always be safely controlled.
What Can I Expect Looking to the Future?
In the future, I think we will rely more on non-drug approaches to pain. The trick will be to figure out who is most likely to respond. A person's expectations of benefit may affect how well a particular non-drug pain treatment works. Look for more studies that explore the impact of non-drug approaches, such as massage or acupuncture. The studies likely will focus on outcomes such as patient satisfaction, medicine use and cost of care.
