To help you get ready to talk with your doctor before surgery, this page reviews common pain treatments used in hospitals and your recovery at home. There are many types of treatment plans — some with drugs and some without, and some pain treatments administered before, during, and after surgery — that can be used together or separately to provide relief based on your specific needs, so discuss your choices with your medical team.
In addition to keeping you comfortable, good pain control can help your recovery, reduce the chance of complications and unwanted side effects from your medications, and prevent the pain from becoming chronic. So if your pain treatment doesn’t seem to be working, tell your doctors. Without your feedback, they can’t optimize your pain management plan.
Because pain management varies with the type of surgery, it’s not possible to review every possible treatment, so links to additional information can be found at the bottom of this page and in the Resources section.
Pain management should be “multimodal”
Multimodal pain management refers to the use of different types of treatments to alleviate your pain. A multimodal approach varies the types of pain medicines used, so your doctor can avoid exposing you to very high doses of any one medication, which can help reduce your chances of experiencing side effects.
While there are many different combinations of treatments that can go into a multimodal plan, the trend is to use non-opioid medications at the start of treatment to limit (or in some cases eliminate) your need for opioids, which may be associated with unwanted side effects that can impact the recovery process.
Doctors combine what they know about you (which is why discussions with your doctor are essential), their experience with patients like you who’ve undergone similar surgical procedures and medical guidelines to create the most appropriate surgical pain management plan for you.
These are pain medications that you take by mouth as a pill, gel tablet or liquid. Oral medications can be divided into two groups — opioids and non-opioids — based on the active ingredients in the drug.
Medications that contain opiates as the active ingredient are strong pain relievers used to treat moderate to severe pain. There are different versions of opiates, and while they can be effective pain relievers, how fast they work, how long the relief lasts and the risk of side effects varies. These are all important issues to discuss with your doctor.
Opioids are potent painkillers that can be safe and effective if taken properly for a defined, short period of time. When prescribed or taken improperly or for too long, it’s possible to become dependent on or addicted to opioids. This doesn’t mean that you should avoid them if your doctor prescribes them, but you should talk to him or her about the expectations for how long you should take the medication and when you should reduce your dose. Pain treatment guidelines include the use of opioids, but they also suggest options to reduce their role. The use of opioids, non-opioids and options to minimize opioid use are issues you can discuss with your doctor.
Common side effects associated with opioids include nausea, vomiting, drowsiness or constipation. If they arise, they can stop on their own, but if they continue, your doctor can reduce the dose or prescribe a different opioid.
Non-opioids can be further categorized based on their active ingredient, usually aspirin, acetaminophen or a non-steroidal anti-inflammatory (NSAID) such as naproxen or ibuprofen. Another family of NSAIDs contains a different active ingredient called cyclooxygenase-2 (COX-2)-selective inhibitors.
Acetaminophen- and NSAID-based medications are available over the counter (without a prescription); some NSAID treatments require a prescription when greater amounts of the active ingredient are needed.
Although over-the-counter medications are generally safe, always follow your doctor’s instructions. NSAID medications have the potential to cause stomach irritation and carry other risks depending on your medical history, which is why your complete medical and medication history is an important part the conversation with your doctor. There are also potential risks associated with acetaminophen.
Other non-opioid pain treatments used to manage post-op pain include gabapentin, a treatment for epilepsy, and pregabalin, which is used to manage nerve pain in people with diabetes. Both are categorized as anticonvulsants, not NSAIDs.
Prior to or after surgery, a catheter (a very thin, hollow tube) is inserted into the back so that pain medication can be delivered to the area directly near the nerves that carry the signals that create the sensation of pain.
Like PCA, the patient controls delivery of the pain treatment. With epidural analgesia, a pain medication is delivered directly to the nerve area near the spine; with intravenous PCA, the pain treatment gets to the nerves via the bloodstream. Epidural PCA can provide rapid relief because the medication is delivered directly near the nerves. The type of medication delivered will be determined by your healthcare team.
The table below provides a brief summary of common pain medications, how they're administered and their common side effects. You can review this and other helpful information related to common pain treatments in a booklet from the American Society for Enhanced Recovery. If you'd like more detailed information about drugs to manage pain, the drug search page at MedlinePlus is a helpful resource. But always discuss any treatment questions with your doctor.
Anesthetics such as lidocaine and bupivacaine eliminate pain by preventing nerves from transmitting the signals that carry the sensation of pain. The novocaine used by your dentist to numb your mouth before you have a tooth pulled or a filling put in works the same way.
During or after surgery, an anesthetic can be injected into the surgical site to numb the area and provide local pain relief in the area where the surgery occurred for anywhere from a few hours to a few days after the procedure. If your surgeon wants to prolong the effect, he or she may administer a long-lasting version that slowly releases the numbing medication over time to last as long as the most severe postsurgical discomfort.
Prior to surgery, an anesthetic can also be injected into an area with bundles of nerves (such as near the spine) that transmit pain signals from a broader section of your body to provide regional pain relief. The procedure called epidural anesthesia delivers the anesthetic just outside of the fluid-filled sac that surrounds the spinal nerves. When the anesthetic is delivered into the sac, the technique is called spinal anesthesia.
Nerve block is a term used to describe the injection of anesthetics near a cluster of nerves to numb the appropriate area of your body extremity (arm, leg, head) that requires surgery. This is a form of regional pain management.
Electrical stimulation applied to the skin has also been used to manage pain at specific locations on the body. Some versions of this treatment stimulate areas near the skin; some stimulate deeper.
Cryoanalgesia relieves pain by freezing the affected nerve, causing an interruption of pain signals to the brain. This method is typically used to relieve pain from peripheral nerves (nerves that connect the brain or spinal column to areas outside the central nervous system).
This type of focused cold therapy applied directly to the nerve can provide pain relief for up to 90 days, allowing patients to function more comfortably and experience less pain. The effect on the nerve is temporary.
Complementary and alternative medicine (CAM)
“CAM” refers to treatments that may be used as a complement to or as an alternative in place of the more standard treatments discussed above.* CAM treatments include acupuncture, meditation, relaxation techniques, massage therapy, spinal manipulation, tai chi, yoga, dietary supplements and other natural products.
CAM medicine is actively studied — the National Center for Complementary and Integrative Health (NCCIH) is a National Institute of Health research center that performs and funds research that investigates the effectiveness of CAM methods.
As with any pain treatment, you’ll need to speak with your doctor to find out if CAM is right for you.