subject: Pain After Surgery That Won't Stop Hurting [print this page] Pain After Surgery That Won't Stop Hurting
More than 60 million surgeries are performed every year in the United States, and most of them have good outcomes. Typically, patients who undergo surgery experience pain right after surgery. This acute postsurgical pain can be severe, but typically diminishes with time. Inpatients usually receive pain medication through an intravenous line, while outpatients may take home some prescription pain killers to get them over the first few days or weeks.Persistent postsurgical pain or PPP is a condition in which pain following surgery continues for two months or more after the surgery for no apparent reason.To be fair, pain can follow a surgical procedure for any number of reasons. If inflammation or infection occur as a result of the surgery, that can cause postsurgical pain. If a patient has surgery but the patient's underlying disease comes back (such as cancer) that can cause pain to persist long after surgery but it would not count as PPP. PPP is pain that occurs when no such causes are obvious.PPP is more common than most people realize. It can occur in 5% to 50% of surgical patients, depending on the type of procedure. Amputations often involve PPP, for reasons that are not entirely clear to medical science. Many people who have a limb amputed experience the weird phenomenon of "phantom limb pain." They experience pain, sometimes even intense pain, in a limb that is no longer there. Today it is believed that crossed signals from the nerves are responsible for phantom limb pain.PPP is more common in some procedures than other. Physicians have noticed that amputations, mastectomy, and open-chest surgeries (thoracotomies) seem to have higher incidences of PPP than other procedures.It is still not clear what causes PPP although there has been considerable interest in this topic in the past 10 years. Further, physicians are trying to figure out ways that might reduce the risk of PPP. There are some things that are suspected to increase the risks of getting PPP, including the degree of nerve or tissue damage that occurs during surgery, the kinds and types and durations of anesthesia, and how much time the patient spends in surgery. Even the patient may play a role.For example, scientists who study pain have observed that the pain threshold--the point at which a person registers a stimulus as being painful--varies among individuals. Some people have higher pain thresholds than others, meaning that some people can tolerate more pain.From studies to date, PPP appears to be complex. It can involve different types of pain. Nerve damage is thought to play a role, but it is unclear how this works. Nerves are typically damaged during surgery but such damage does not always result in PPP.PPP may resolve in a few months on its own. The pain associated with PPP can be slight to severe. It may be ever present or it can come and go. PPP may last for months or even years; it can also go away on its own. If you think you may have PPP, talk to your doctor. If you have persistent pain after surgery and you do not feel that your pain is being managed well, ask your regular doctor to give you a referral to a pain specialist. While nobody is guaranteed a pain-free life, most pain can be managed. There are probably things that can be done to at least reduce if not eliminate your pain.
