Q&A: Acute Postoperative Pain Medicine
An Interview with Frances Chung, M.D.
Frances Chung, M.D., is an anesthesiologist and professor within the department of anesthesiology and pain management at the University of Toronto’s University Health Network. She has a research interest in acute pain and her studies have been published broadly, including in ASA’s peer-reviewed journal Anesthesiology. The following is an interview with her about acute postoperative pain medicine.
ASA: What is acute postoperative pain?
Dr. Chung: Acute postoperative pain is the pain felt immediately following surgery or an injury as a result of the trauma to the tissue. This pain can be treated and lasts no more than three months.
In the postoperative period, each patient should be evaluated separately to measure the extent and source of the pain. Once I learn this information, I can provide the patient relief. It is important for patients to seek expert physician advice as soon as possible regarding pain treatment. Left untreated, acute pain has a chance of becoming chronic pain.
ASA: Who treats acute postoperative pain?
Dr. Chung: Anesthesiologists are pain medicine specialists. They are doctors of medicine (M.D.) or osteopathy (D.O.) who make sure that patients are safe, pain-free and comfortable during and following surgery. Frequently the anesthesiologist heads a team of other specialists and doctors who work together to help treat pain. The anesthesiologists or other pain medicine doctors (such as neurologists, oncologists, orthopedists, physiatrists and psychiatrists) and non-physician specialists (such as nurses, nurse practitioners, physician assistants, physical or rehabilitation therapists and psychologists) all work together to evaluate the patient’s condition. Then this "team" of specialists develops a customized treatment plan.
ASA: Why is it important for acute postoperative pain to be treated?
Dr. Chung: No one wants to be in pain. However, it’s particularly important to treat postoperative pain because studies show it leads to better overall surgical outcomes., By effectively treating a patient’s pain, doctors increase that person’s comfort level and better prepare him or her for the rehabilitation process, which in turn accelerates the recovery process.
ASA: How is postoperative pain measured?
Dr. Chung: Similar to all other types of pain, acute postoperative pain is measured on a 10-point scale, where one is no pain and 10 is the most excruciating pain possible. Because pain is subjective, all patients are asked to gauge their pain on this scale.
ASA: Why do some people experience more pain after surgery than others?
Dr. Chung: Each person has his or her own predisposition to pain. However, patients who feel anxious are more likely to experience higher levels of pain following surgery. Additional factors include preoperative pain, age and surgery type.
ASA: How is acute postoperative pain treated?
Dr. Chung: There are a number of ways to treat pain after surgery based on a variety of factors, which each patient’s physician will assess. A widely used approach to acute postoperative pain is patient-controlled analgesia, which is administered intravenously. There are multiple medications/treatments available to patients for post-operative pain including: opioids, acetaminophen, NSAIDs, COX -2 inhibitors, NMDA, Gabapentin, regional anesthesia, peripheral nerve catheter and local infiltration. Another alternative approach to treating acute postoperative pain is the ancient Chinese practice of acupuncture.