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Pain after surgery or injury

It's not about "toughing it out"

Many people who are scheduled for surgery say, "I don't need anything for pain after my surgery!" The same after an injury. But preventing pain and relieving pain are not issues of whether one is "tough enough" to withstand pain. Appropriate pain therapy that averts the body's reactions to pain can speed recovery and prevent complications.

Pain management is important because significant changes occur in everyone as a result of tissue injury, regardless of whether it occurs in an accident or through surgery. Pain is the body's early warning system that alerts us to potential damage. But the changes resulting from pain can actually be harmful to the body's recovery.

Everyone has a different response to a similar painful stimulus. The differences are partly due to:

  • age
  • cultural or religious expectations
  • current emotional status
  • general medical status
  • pre-existing pain problems (e.g., arthritis)
  • prior experiences and expectations regarding pain

The body's system for processing the sensation of pain is very complex, and involves many different layers. Each layer may either amplify or suppress messages from an area of injury. When strong pain messages run unchecked through the body, they can end up doing further harm to the body as a whole, causing, for instance, the stress response or the evolution of chronic pain.

Pain medication and other techniques target these various layers of processing in an effort to help increase the body's own ability to limit the consequences of tissue injury and pain.

One layer of pain processing goes on at the level of the pain messages sent between the area of injury (surgical site or bone fracture) and the spinal cord. Basic and clinical research has led to exciting progress that allows us to predictably modulate the pain messages at this level. Let's look at what happens when tissue injury occurs.

Tissue damage turns on a cascade of nerve messages to the spinal cord

With an injury (cut, crush, fracture), local tissues are disturbed. Special pain-sensitive nerve endings are directly stimulated by the injury or indirectly stimulated from chemicals released by the damaged cells. These nerve endings send messages along the nerves to the spinal cord.

A cascade of nerve messages travels from this zone of tissue damage to a specific area in the spinal cord that is similar to a relay center where the nerves connect with other specialized nerves in the spinal cord. These, in turn, connect to many other nerves, sending signals up and down the spinal cord. This increased activity is termed wind up.

The excited specialized nerves in the spinal cord, in turn, send messages back down to the area of injury, but now covering a wider area. This returning signal causes the common effect of local tenderness, swelling, and muscle spasm. The excited spinal cord simultaneously relays these messages up to the brain, causing us to perceive the pain.

This whole process takes a few minutes and is the normal sequence of events designed to protect us from further tissue injury. Because of the returning round of neural messages, a wider injured area becomes painful to touch, muscle spasm slows down normal movement, blood pressure may rise, and we may break out in a cold sweat. Although this may protect the area after an accident, it is hardly the situation we would desire after a surgical procedure.

Surgical pain management gets you on your feet more quickly

Fortunately, current pain management therapies can target the primary injured zone and prevent the second relay of nerve messages to the injured zone and the brain that cause wider involvement. Thus, now we can undergo major surgery and be up and about shortly after the procedure, in comfort.

By understanding the processes of pain we are able to prevent surgical pain, rather than just treat the consequences of pain, with fewer side effects by combining different medications, refining routes of delivery, and using different types of treatment.

 
Peter Burgi, MB.Bch 
in association with the MediResource Clinical Team 


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