Taking the right pain meds at the right moments after surgery has more perks than minimizing pain alone. The National Institute of Health informs that taking your post-operative pain meds as prescribed has several benefits over trying to avoid medication.
Appropriate pain medication leads to shorter hospital stays, less chronic pain, and lower overall intake of painkillers.
Other benefits are:
- less pain makes you feel more comfortable, which aids the healing process
- increased mobility, start walking sooner, will help you get your strength back sooner possibly leading to an earlier discharge.
- fewer complications thanks to well-controlled pain such as pneumonia and blood clots
Which painkiller is appropriate?
Which painkiller to take depends from person to person. Everybody is different. Also the type of surgery and even which hospital and surgeon you have play a role.
Post-surgery pain medication. What are your options?
Painkillers used after surgery can be taken orally, by injection, or via intravenous delivery. The most commonly prescribed meds are:
- Narcotics such as codeine and morphine. Also known as opioids, these medications involve drowsiness, and impaired judgment.
- Acetaminophen. An analgesic drug better known as paracetamol. Acts as a pain reliever and a fever reducer.
- Combinations of acetaminophen and narcotics, such as Vicodin, Lortab, or Percocet. May also make you drowsy.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Primarily used to treat inflammation, mild to moderate pain, and fever. In case of surgery especially around a wound that might be causing your pain. Some NSAIDs can make you drowsy.
- Local anesthetics. Instigate a local analgesic effect in a specific area. They do not make you drowsy.
Benefits of non-narcotic pain medications
Non-narcotic painkillers involve a slightly higher risk of gastric irritation. This however is balanced by the advantages of not taking narcotics which include:
- avoiding dependence issues
- avoiding or reducing constipation
Which post-op painkillers to take at home
In general, after surgery simple painkillers are recommended and or prescribed. These include paracetamol, NSAIDs (e.g. ibuprofen and diclofenac) and codeine or similar drugs (such as; dihydrocodeine, oxycodone and tramadol).
When taking these meds you are likely to still experience pain but when taken regularly they will make your recovery more comfortable and reduce the need for other painkillers.
The Cochrane Library has 35 reviews of oral analgesic interventions, with 38 different drugs, at various doses involving 45,000 participants in about 350 studies. An examination of these studies led to the conclusion that:
The most effective drugs for the largest number of people were:
- <ketoprofen, which is sold as Orudis;
- 600 milligrams of ibuprofen; 1,200 milligrams of aspirin;
- and combinations of Tylenol with either ibuprofen, codeine or oxycodone.
Codeine alone and lower doses of ibuprofen were largely ineffective.
“Of the analgesics you can get over the counter, the best combination is ibuprofen and Tylenol — 200 milligrams of ibuprofen and 500 of Tylenol has a 74 percent success rate,”
according to Prof. Andrew Moore of the University of Oxford. Source, The New York Times.
Not all painkillers work for everyone. As a meta study on “Single dose oral analgesics for acute postoperative pain in adults” concluded:
Commonly used analgesic drugs at the recommended or licensed doses produce good pain relief in some, but not all, patients with pain. The reasons for this are varied, but patients in pain should not be surprised if drugs they are given do not work for them. Alternatives analgesic drugs or procedures should be found that do work.
Following the same study the researchers also concluded that most oral painkillers did not have side effects except for opioids. Participants who were given opiods, (for example, codeine, oxycodone) experienced side effects whereas people taking other meds did not.
If you are expected to have more severe pain, your doctor or surgeon will prescribe a narcotic painkiller.
NSAID painkillers and the risk of post-surgery bleeding
Taking NSAIDs before surgery should be avoided. All medical experts agree on that. Opinions on the consequences of taking these medications post surgery differ greatly.
Studies show there is a (theoretical) increased risk of excessive bleeding and bruising after surgery.
Proponents of taking NSAIDs after surgery
Some surgeons advice to stop taking NSAIDs two weeks prior to elective surgery and one or two weeks after surgery. The reason is because they can affect the platelet function in your blood and affect the ability of the blood to clot.
Other surgeons state that real bleeding usually has a surgical cause and is not from medications. They say that patients taking medications, vitamins, homeopathic drugs without informing their surgeons is often blamed for such after effects.
They think there is no reason, apart from theoretical reasons, not to take non steroidal anti inflammatory medications after surgery.
“the use of Ibuprofen (Advil, Motrin etc) and Naproxen (Aleve) is usually extremely helpful with minimal risk to an increase in clinical bleeding.” Source, RealSelf.
Surgeons who are recommending taking Ibuprofen and other anti inflammatory medications say they are actually beneficial because of their anti-inflammatory response.
- they help abate the post-surgical inflammatory response that prolongs the pain, soreness, and swelling after surgical trauma
- they can be take with narcotic pain meds (or render taking these unnecessary)
Opponents of taking NSAIDs after surgery
Other surgeons believe that Ibuprofen, as well as aspirin, Aleve, Advil and other variants are not supposed to be taken within a week before and a week after a surgical procedure.
They say these painkillers affect clotting and “could lead to quite a bit more bruising and even complications”. Therefore they often recommend taking only Tylenol Extra Strength.
Conclusion about the “should you take NSAIDs after surgery?” controversy
It seems that most surgeons agree that these medications can be taken after almost every kind of surgery. Of course, as always, it is strongly recommended to follow your doctor’s recommendations.
The physician that performed your surgery and your doctor know you and your personal situation best.
Best painkillers after surgery. Paracetamol vs Ibuprofen
A reason to prefer paracetamol over Ibuprofen could be that animal studies have also shown that ibuprofen hampers the ability of muscles to rebuild themselves after exercise.
Since surgery recovery is all about rebuilding tissue this may be something to take into account. On the other hand, it’s only one animal study and no hard conclusions can be drawn.
Heart attack patients and the risks of taking certain painkillers
Patients who had suffered a heart attack should be really cautious in choosing painkillers. A Danish study showed an increased chance on a second heart attack or death after taking certain pain medications.
Patients taking Celebrex had double the risk; patients taking the generic diclofenac had 1.9 times the risk, and those taking ibuprofen had 1.3 times the risk, the study found.
Based on the findings, doctors should avoid prescribing non-steroidal anti-inflammatory drugs for these patients, or give them at low doses.
Alternative pain relief
Once consigned to the periphery of the world of medicine, alternative therapies are now accumulating recognition. Both patients as well as medical professionals are increasingly embracing alternative medicine.
A report in the journal Health Services Research found that doctors and nurses are increasingly likely to try alternative or complementary medicines themselves.
Here are some alternative, natural pain relief remedies.
Willow bark extract
Willow bark extract showed a moderate analgesic effect in osteoarthritis and appeared to be well tolerated. Source, PubMed.
The Boswellia serrata tree is indigenous to India. The health benefits of its gum (guggulu) have been known for centuries. Its therapeutic value lies in potent anti-inflammatory, anti-arthritic and analgesic activity.
Boswellia extract posses good anti-inflammatory, anti-arthritic and analgesic activity. Source, PubMed.
Turmeric, or more specific, the active ingredient in turmeric, curcumin, a very healthy spice lauded for its anti-cancer benefits shows “to ease pain and improve function about as well as the ibuprofen.”
Dr. Minerva Santos, director of integrative medicine at Northern Westchester Hospital in New York said she recently suggested to her father that he try turmeric after an operation on his hip. He was undergoing rehab and was experiencing pain and stomach issues, another area in which the use of turmeric has been studied.
“He was skeptical,” she said. “But he called me up a few days later and said he was pain-free.”
She recommends taking 1000 mg a day. Taking supplements has benefits because these often contain piperine, which aids absorption. Turmeric should not be taken two weeks before surgery since it may affect blood clotting. Source, NY Times Well.