Health Education Library / Post-Op Pain

Pain after an operation (post-op pain) is normal and expected. These guidelines can help you stay as comfortable as possible.

Taking Pain Medications Take medications on time. Do not take more than prescribed. Take only the medications that your health care provider tells you to take. Take pain medications with some food to avoid an upset stomach. Don't drink alcohol while using pain medications.

Types of Pain Medications

Analgesics (non-opioid and NSAID)
Remove feelings of pain. Used for mild to moderate pain. May prevent joint and soft tissue inflammation. Over-the-counter (such as acetaminophen and ibuprofen) or prescription. All relieve mild to moderate pain and some reduce swelling. Possible Side Effects include nausea, stomach pain, ulcers, indigestion, diarrhea, bleeding, kidney or liver problems.

Opioid:
A type of analgesic. Remove feelings of pain. Used for moderate to severe pain. Always prescription. Possible side effects include stomach upset, nausea, and itching. May cause constipation (to help prevent this, eat high-fiber foods and drink plenty of water).

Anesthetics
Stop pain signals from reaching the brain. They block all feeling in the treated area. Possible side effects include Nausea, low blood pressure, fever, slowed breathing, fainting, seizures, heart attack.

Non-Medication Relief

Medications are not the only way to manage pain after surgery. Try the following techniques.

Ice or Heat
Use the one checked below as needed (but for no longer than 20 minutes at a time): Ice pack or bag of frozen peas wrapped in a thin cloth Covered heating pad (not too hot)

Visualization
Visualization helps take your mind off the pain: Close your eyes. Breathe deeply. Picture yourself in a quiet, peaceful place. Imagine how you feel in that place. If other thoughts enter your mind, take a deep breath and try again.

Progressive Body Relaxation
Relaxation helps relieve stress and pain: Close your eyes. Clench your foot muscles. Hold for a few seconds. Release. Repeat with the muscles in your calves. Work slowly up your body.

Deep Breathing
Deep breathing relaxes your whole body: Inhale slowly and deeply as you count to 5. Hold your breath for a couple of seconds. Exhale through your mouth as you count to 10.


Managing Pain After Amputation Surgery

Describing the location and nature of your pain helps your healthcare team decide how best to treat you. No matter what kind of surgery you have, pain is always a concern. As with any surgery, pain after amputation can be controlled. This can help you stay more comfortable. People react to pain in different ways. So learn how to describe your pain to your healthcare team. This means explaining where the pain is, how it feels, and how bad it is. This lets the healthcare team know how best to treat your pain.

Types of Residual Limb Pain
Pain in your residual limb can be coming from different places. The following are the most common sources of limb pain after amputation: Skin can be very sensitive after amputation. Pain from your skin can feel sharp or irritating. Nerve pain can range from tingling to feeling like an electric shock. The source of nerve pain may be a neuroma. A neuroma results when the ends of cut nerves grow into a painful ball under the skin. Muscle pain can feel like aching and cramping. Bone pain can occur if the end of the bone presses against the socket of your prosthesis. This may cause deep or sharp pain.

Explaining Your Pain
Only you know how your pain feels. After surgery, your goal is to get better. Pain relief plays a big part in your recovery. Be honest when a doctor or nurse asks about your pain. On a scale of 0 to 10 (if 0 means no pain, and 10 is the worst pain), how does it feel? Also mention the type of pain. Is it aching, burning, sharp, twisting, dull, or does it feel like an electric shock? Be sure to say how often the pain is happening.

Treating Pain
Your doctor may need to try different medications or dosages. This can help find the most effective way to treat your pain. The most common pain medications used after surgery are opioids (narcotics). Opioids block pain signals on their way to the brain. This means they can control even severe pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be used. Like opioids, NSAIDs block pain signals on their way to the brain. Your doctor may also try antidepressants or anticonvulsant medications. They are commonly used to treat depression and seizure. But they have proven effective at relieving pain related to amputation. There are other things your doctor may recommend if medications do not help control your pain. Here are some common examples: Acupuncture, TENS (transcutaneous electrical nerve stimulation), Biofeedback, Hypnosis, Meditation.


Phantom Sensation and Phantom Pain After Amputation

Most people who have an amputation will have some degree of phantom sensation. This is when you "feel" the missing part of your limb. You may feel an itch or a tickle. Or it may feel as if the missing portion of your leg is asleep. It is most often mild, not painful. But sometimes, you may have stronger, painful sensations that seem to come from the missing part of your leg. It may feel like a quick zing or flash up your leg. Or, it may feel more like burning, twisting, cramping, or aching. When this happens, it's called phantom pain. The good news is that persistent phantom pain is far less likely to happen than phantom sensation. And there are things you can do to feel better.

What Causes Phantom Sensation?

No one is sure why phantom sensation happens. One common theory has to do with nerves. Nerves that supplied sensation to the missing portion of your limb are often still functioning. They are just higher up in your leg. This means that your brain may not know how to interpret signals from these nerves. Your brain may think that the signals are coming from the missing part of your limb.

Phantom Pain

Phantom pain is likely to come and go. It may happen more often at night. Keep in mind that you won't necessarily have phantom pain after your amputation. It's far less common than phantom sensation. Phantom pain is most often manageable. But if it becomes hard to live with, talk to your healthcare provider. Once sutures or staples come out, spend time every day gently rubbing and tapping your residual limb. This will help desensitize it.

Treating Phantom Pain

There are several ways to treat phantom pain. If needed, ask your healthcare provider if any of these options might work for you. The ones listed below are the most common treatments. Your healthcare provider may recommend others.

Medication
Antiseizure medications or antidepressants are often used to treat phantom pain. They may work better for this type of pain than normal painkillers.

Frequent touch
Massaging, rubbing, and tapping the end of the residual limb helps with desensitization. This can lessen or relieve pain. You may begin massaging your residual limb once the surgical sutures or staples are removed.

Wearing a shrinker sock.
Keeping constant pressure on the end of the limb may help to relieve phantom pain.

Using your prosthesis
Like wearing a shrinker sock, using a prosthesis provides steady pressure to the limb. This seems to reduce phantom pain for some people.