Advice for helping your patients manage pain after surgery
Patients should know how to adequately communicate their pain levels after surgery.
Having been on the battle lines in the post-operation pain world for many years, I've compiled some suggestions for clinicians on how to help any patient expected to undergo major surgery manage pain:
Tell the patient to probe in the pre-op, pre-anesthesia appointments about what to expect as far as pain. Of course, it varies widely from patient to patient, but make the patient doesn't let other providers blow off the issue by saying things like “oh you'll be fine!”
Suggest that a patient asks questions like “have you seen patients with this same surgery who have had difficulty with pain control?” “If my pain is not well controlled after surgery, what should I do?” Clinicians should be able to address these concerns.
A patient should ask if there is a “pain service” in the hospital, and ask how to reach the service post-op if things are not going well with pain control. Many medical centers have anesthesiology pain services, who are often asked to take control of the patient's pain regimen when things are not going well.
The problem is that is can be impossible to get to these providers, or to get the surgical team to ask for their help. Much is this is political, as many surgical teams think that pain services coddle patients and needlessly extend their stays.
Some of it is financial, because when surgical teams engage pain services, they are often “dinged” by the wacky hospital payment system that reward shorts stays and minimal specialty care.
A patient should practice using these words in order to prepare his or herself for when things are not going well with post-op pain. When a patient is asked how is his or her pain is doing, the patient should think in terms of either being satisfied, or not satisfied.
If a patient expresses dissatisfaction, he or she should firmly say “I am not satisfied with my pain control.”
Don't let specialized providers off the hook when they throw out demands to rate a patient's pain on a scale of one to 10, etc. A patient should cut to the chase, and say “I am not satisfied with my pain control.”
Patient satisfaction is all the rage in hospitals, and high patient satisfaction scores are a precious commodity. So patients should use the same words: “I am not satisfied with my pain control.”
The surgical team may try to make a patient speak in terms of “good” of “bad” but stick to “not satisfied” because that will spur action from providers.
If a patient's concerns are not quickly addressed, ask “Is there a Pain Service here, and could I have them see me please?” Advise the patient to be persistent.
If things still are not going well, the patient should ask to speak to the charge nurse on the floor, and again speak in terms of “not satisfied.”
Sometimes charge nurses and floor staff will stonewall patients, siding with the surgical team and just trying to get a patient to accept their pain with lines like “now remember, some pain is to be expected.” Advise that the patient not to buy into this.
Certainly, there will be some discomfort, but it is reasonable to expect that all post-op pain control should include the patient not being distressed, not being in tears, being able to rest quietly, and being able to interact with those around the patient calmly.
If charge nurses are not able or willing to help, a patient can ask to speak to someone from the medical center's “Patient Relations” staff. Most hospitals have such a thing, and they will help.
Suggest that a patient look for numbers on signs in the room and in the halls that say “if you are not satisfied with your care, call this number...” Call it.
A patient shouldn't try and please the surgical team with polite behavior and the patient talk to their families about this as well. Many patients and families are deferential to medical teams because they want to be nice, to be seen as cooperative, etc. But, attempts to please in this way can lead to rough going with pain control. In fact, it is the medical teams who are the ones who should be trying to please the patient.
The patient's family should to be ready to go to the mat for the patient if needed. Yelling and hollering will get you nowhere, and being less than civil to your team will likely result in your receiving punitive care.
Many patients go to war with staff, and end up with worse care because nurses and medical teams are human. Advise that your patient to keep it calm, respectful, and business-like, but the patient and his or her family must be ready to be strong, calm and demand that the patient's concerns be addressed if pain control is not satisfactory.
I don‘t mean to scare you. Rest assured that most post-operative pain control is uneventful with satisfied customers doing just fine, and your patient will likely be in that category. But if he or she is not, use these skills to get rapid response. The best bet is to stay out of the hospital, but if a patient must go, make sure he or she is ready to be a strong and calm advocate for satisfactory pain control. Good luck!
Jim Anderson, MPAS, PA-C, ATC, DFAAPA, is a physician assistant in Seattle, WA.