Regional Anesthesia & Pain Management (RAPM)

Patient Information

Options for Pain Control

What are my options for pain control?
There are a number of ways to manage your pain after surgery. Your doctor or anesthesiologist will know how much pain you can expect and what the usual options for pain control are. Options for pain control include:

• Pills or tablets
• Intravenous (IV)
• Shots with a needle
• Patient Controlled Analgesia (PCA): intravenous medicine that you give yourself by pressing a button.
• Epidural: medication that goes through a thin tube into your back. You can also give yourself extra medication by pressing a button.
• Nerve Block: freezing a nerve with a shot from a needle, or by a thin tube placed near your nerve.

Can you tell me more about my options?

• For mild pain, you might just need painkillers that you take by mouth. For example, Tylenol #3 (acetaminophen, caffeine and codeine) or Percocet® (oxycodone and acetaminophen) might be prescribed.
• For moderate to severe pain you will probably need something stronger like morphine. Morphine and other opioids can be given as “shots” into the muscle (intramuscular) or under the skin (subcutaneous).
• The preferred way of giving morphine is by a computerized system called a Patient-Controlled Analgesia (PCA) device (see section on Patient Controlled Anesthesia).
• Another option for pain control at the University Health Network (UHN) is by Epidural (see section on Epidural Pain Management).
• At the Toronto Western Hospital site (TWH) we also use Peripheral Nerve Plexus Blocks (see section on Regional Anesthesia).
• If you need a PCA, epidural or plexus catheter you will be seen and managed by the Acute Pain Service. We will work with your doctor to make sure that your pain is controlled.
  No matter how much pain you have or which methods are chosen, oral anti-inflammatory medications like aspirin may also be used.

Why don’t I just get pain “shots” or injections to control my pain after surgery?
There are a number of problems with pain-shots:

• Some people do not like needles and find them painful and stressful.
• Some people do not like to have to call a nurse every time they feel pain, or they may be upset if they have to wait for a nurse.
• Even when the pain medicine is given it takes time to work.
• The effectiveness of this method is variable and hard to predict compared to other methods.

Are there options for pain control that do not rely on medications?
There a number of ways to help control pain that do not rely on medications:

• Heat or cold
• Deep, slow breathing
• Imagery
• Relaxation
• Distraction

Ask your nurse or doctor if any of these methods would help you. Some people find self-hypnosis, deep breathing, relaxation training, and progressive relaxation helpful. Focusing on something other than the pain can also help with pain control (e.g. playing video games, reading a book, or visiting with friends or family).

My family member/friend does not speak English. How can I make sure he/she knows about pain control options?
If there is no one who can interpret for the patient please tell your doctor or nurse well in advance so that a hospital interpreter can be present.

You can also ask for an appointment before the surgery to talk about pain control. This can often be done on the day you come to the hospital for your lab tests, nursing and physiotherapy assessments, and teaching.

What can I do before surgery to have less pain afterwards?
You will be less anxious if you understand what your surgery involves and what to expect after it. The less anxiety you have about your surgery the better. If you have chronic pain, the more stable your condition is before the operation the better. People who have a positive outlook tend to do better as well.

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