Question: Hi! On Jan. 15, I had brain surgery to remove a tumor. As I recuperate, I am taking less and less pain meds, and I would like to know what I will be permitted to take once I have the staples in my head out. The doctor said no ibuprofen because it promotes bleeding, and I am allergic to Tylenol. — Dawn
As a practicing surgeon, I must state you should always discuss these questions directly with the surgeon who performed the procedure. Only the surgeon who performed the procedure knows exactly what he or she did during the procedure. This is very important, as they are also the only person who can truly determine the risk of any of your actions, including the risks of the various medications you may take.
That being said, my advice to you is to ALWAYS speak with the performing surgeon prior to starting any new medications or starting any new activities in the immediate period after a surgery. This is especially important if it is a medication you have never taken before or an activity you have never done before, as the surgeon would have had no way to have accounted for it in his or her conversations with you prior to and immediately after the surgery.
Now that we all know to speak with our surgeons before making any changes to our medications or activity levels after surgery, let me give a brief overview of post-operative pain management. First, I think it should be understood that all surgery causes pain. Though at times the procedure may cause mild pain, no method of pain control is expected to make you pain free after an operation. The recent and ongoing opioid epidemic has made this aspect of surgical care even more difficult but has also led to an increase in research in the area.
In our quest to minimize opioid usage, modern surgical practice now includes what is called multimodality therapy. The purpose of this method is to use multiple different non-narcotic medication-based therapies combined with physical therapies as well as mind/body relaxation techniques, such as yoga and meditation, to achieve non-narcotic based pain control.
At Lima Memorial, we would start with preoperative anti-inflammatory medications and anti-nausea medications, combined with nerve blocks performed by an anesthesiologist prior to surgery, to minimize the pain before it starts. We combine this with nerve-based non-narcotic medications to minimize the associated nerve pain. Once the surgery is completed, the patient may receive a short course of narcotic medication, but current practice is to minimize the narcotic usage and get the patient moving quickly. This is typically done by including our physical and occupational therapists.
Early activity is one of the best ways to minimize long-term pain and get the patient back to their pre-operative self. Staying in bed after a surgery leads to many problems, including pneumonia, muscle weakness, clot formation and worsening pain control. The body is designed to move and, unless the surgeon tells you to be on bed rest, one should start to get up and move to the level that your surgeon has allowed.
In the end, there is no one size fits all answer to how to manage post-operative pain. But but don’t underestimate how much getting up and moving early, including the use of meditation and exercises like yoga, while pushing through the pain will help lead you to a faster and less painful recovery.
Jeremy Heffner, MD, General Surgeon, Midwest Surgical Specialists