For anyone facing an impending surgical procedure, it’s pretty normal to come face-to-face with a range of fears and emotions in the lead-up to the big day. In the context of chronic pain, the prospect of surgery to assist with pain management can sometimes hold the hope of being a ‘magical cure’, but this is rarely the case. This month, we explore the issue of how to support chronic pain patients in preparing for the reality of a possible surgical intervention.

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The trauma of surgery – both before and after – is part biological and part psychological. So, it makes sense to prepare a patient both psychologically and physically for a surgical procedure.

MANAGING EXPECTATIONS

Although it’s not usually something that patients really want to hear, when it comes to persistent pain, the probability of a reduction in pain post-surgery is almost certainly unlikely to be 100%.

While there can be some improvement in function, and a reduction in pain intensity, many people will go through surgery and still have some pain to contend with, long-term. Depending on the condition, there may be other management options aside from surgery, which are important to include in a considered comparison of risks and quality of life outcomes.

Without adequate preparation, it can be tempting for chronic pain patients to attach a sense of almost ‘blind hope’ to the prospect of surgery as the one thing that will finally ‘fix’ them. In reality, this is rarely the case. To manage these kinds of expectations and maintain a sense of control, it can really help to arm your patient with a combination of knowledge and practical tools.

IMPORTANT POINTS:

  • Support your patient to find out exactly what is involved in the procedure and the recovery process, so that they know what to expect.
  • Encourage a focus on the realities of how things are likely look on the other side of surgery – including worst-case scenarios (in perspective!). This can really help to contain catastrophic thinking during the recovery period.
  • Allow your patient to gather all the facts ahead of time. This way, they will have a realistic understanding of the inherent risks involved, and the most likely level of improvement that they can expect.
  • Offer some simple strategies for managing anxiety and staying focussed.

THE ROLE OF ANXIETY IN POST-OP PAIN MANAGEMENT

Pain is an inevitable part of surgery. It’s the body’s way of alerting the brain that damage has occurred and needs attention. However, as we know, anxiety can also play a big role in the perception of pain intensity.

Regardless of what kind of surgery is planned, there will always be some degree of stress involved – both in the lead-up and after the event, especially if there’s still a lot of post-op pain or things haven’t panned out quite as sweetly as anticipated.

Stress hormones can weaken the immune system and disrupt the body’s ability to manage pain and infection, with potential flow on effects to wound healing and recovery. Given that people with chronic pain are often already living with an elevated stress response it’s important to develop a plan for managing this in order to set them up for the best possible outcomes.

Clinical guidelines now acknowledge that persistent patients may require increased analgesia to manage post-operative pain on top of their existing persistent pain condition.

Making your patients aware of this- and promoting access to tools like breath awareness, mindfulness and other relaxation techniques can have an enormous impact on how they experience pain during the post-operative period.

ACHIEVING THE BEST RECOVERY OUTCOMES

People in pain generally avoid activity as a learned response, so it’s not uncommon for the idea of engaging in rehab post-surgery to bring up fears of further pain. Given the importance of movement, it’s important that patients understand the difference between acute (post-surgery) pain and ongoing persistent pain and use this to develop a plan to minimise avoidance of physical rehab. It helps to talk patients through this and reassure them of the role of rehab as a safe and positive step to feeling better.

Finally, it is really important for pain patients to recognise that the decision to undergo a surgical procedure in the context of persistent pain is a pretty complicated one. It’s not always clear-cut but chances are they had good reasons for choosing surgery – and it’s important to remember this.

Reminding patients that only they can decide on the right treatment for them (in conjunction with a medical team they trust) often helps. And once the decision is made, it’s important that they trust they trust their judgement, acknowledge the risks and give rehab a full effort to lay the pathways for the best possible recovery outcomes.

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