Postoperative pain

Zeljko Kojadinovic, MD- Neurosurgeon and Pain Specialist

Postoperative pain

Zeljko Kojadinovic, MD- Neurosurgeon and Pain Specialist

Pain frequently persists after surgeries. Examples of such surgeries include mastectomy, limb amputation, lung surgery, heart surgery, gallbladder surgery, hernia surgery, various abdominal surgeries, hip surgery, knee surgery, cesarean section and other gynecological surgeries, etc. In many cases, the causes of the pain are completely different from the disease that was treated with surgery. This type of pain occurs after various operations in 5-50% of cases.

Postoperative pains sometimes have a name of syndromes which implies no clearly defined causes for the pain. For example:

after a cholecystectomy (repeated ultrasound and CT scans of the abdomen, gastroscopy, laboratory, colonoscopy, cholecystography, etc.). The setting is a diagnosis of postcholecystectomy syndrome, while in fact it was neuropathic pain
after thoracotomy, pain between the ribs – post-thoracotomy syndrome
after abdominal surgery, pain in the area of the incision with an attempt to resolve it only by wearing a lumbar belt
knee pain after surgery that was no longer the result of knee changes

If pain lasts for several months after the operation, it is important to differentiate between its causes because not all are treated in the same way. Precise pain diagnosis in the first place implies determining which anatomical structure (specific joint, muscle, tendon, nerve, etc.) is the source of pain. Usually, it is not a previously operated disease. After that, the question arises as to which pathological process takes place in it, in order to treat it. This can be achieved only by getting all relevant information about patients’ pain and all other symptoms. Only experts know what information is relevant and how to interpret it. Over 50% of the sources of pain are not detectable by any recordings.

After determining the real cause of the postoperative pain, a combination of different dosages of medication can be prescribed. This combination of medication is always individual and should be adjusted in regular contact with the patient over the first 6 weeks. At the beginning of this period, the pain should be significantly reduced or completely resolved. This should remain throughout the 6 weeks in order to achieve long-lasting results. To provide this during this period, the doctor must be available to the patient at any time so that he can easily contact him if the pain increases.

Sometimes interventional diagnostic and therapeutic methods are indicated.