Please find a list of frequently asked questions and answers on PAIN
Will I have pain after my operation?
Yes, unfortunately limb reconstruction surgery is accompanied by pain post-operatively, but there are many available methods of pain relief which you should discuss with your anaesthetist and the pain team.
How can the pain be relieved immediately after my operation?
You will be given pain relieving drugs while you are under the anaesthetic so that they have taken effect at the time you wake up.
The usual methods of relieving pain are:
- A strong pain killer like morphine will be used. This is given into your blood stream while you are asleep, and afterwards through a machine called a Patient Controlled Analgesia (PCA) machine. You have control of the amount of the pain-killer that you receive. At King’s morphine or oxycodone is used in PCA and is given under the skin (subcutaneous).
- Paracetamol is given to you regularly, either into the drip (intravenous) or by mouth. It may not seem very strong but it lowers the amount of morphine that you need.
- The anaesthetist may give you a nerve block with local anaesthetic that numbs the nerves to your leg. This will last for 6 to18 hours, occasionally even longer. Numbness can feel peculiar but it does wear off. As it wears off pain returns so be sure to use your PCA machine as soon as numbness starts to get less.
Are there any alternatives to morphine?
Yes, there are other equally strong pain-killers such as oxycodone or fentanyl. These are given either into a vein (intravenous) or under the skin (subcutaneous).
Are there any dangers associated with morphine?
Morphine can cause you to become drowsy and your breathing to slow down and become more shallow if you have too much of it. The nurse will check on this at frequent intervals.
Can I overdose myself with a PCA?
If you are using a PCA machine and you become drowsy you will not press the button on the machine. The machine is set to deliver small doses at 10 minute intervals, so you will not overdose yourself. This is called the “lock-out” period.
It is most important that you and only you press the button to activate the PCA.
Can I become addicted to morphine?
You should use morphine for as short a time as possible. You will not become addicted to it in a few days. If you need it for longer than 2 weeks you can become tolerant (need more and more to have the same effects) or dependent (withdrawal symptoms such as shivering, shaking and nausea when it is stopped).
The Pain Team nurses and doctors will come and advise you about other pain relieving drugs if your pain is persistent.
Will my pain last for a long time?
This is very variable, but because of the screws and the frame there tends to be pain and discomfort for several weeks.
What can be done to help persistent pain and discomfort?
Less strong pain relieving drugs are used, such as codeine and Tramadol. If these are not strong enough for you a slow acting morphine tablet taken twice a day by mouth can be used, or a drug called buprenorphine can be given as a skin patch. Paracetamol is safe and this is continued for as long as you need it.
Other drugs, such as Gabapentin and Amitriptyline are often used for nerve pain.
Can anti-inflammatory drugs such as ibuprofen (Brufen, Neurofen) and Diclofenac(Voltarol) be used?
This group of pain killers is not recommended as there is evidence that they can delay bone healing
What are the side effects of pain killers?
Nausea, occasionally vomiting (being sick)
Constipation (you may need laxatives)
Itching all over the body (without a rash)
Difficulty passing urine (especially if you have a prostrate problem)
These side effects may pass or you may need to try a different pain killer.
Long term side effects of morphine and other strong opioids
Drugs like morphine are called opioids. All these drugs lower the hormones in your body after months of use, especially testosterone in men and oestrogens in women. This could have an adverse effect on your bone density which will affect healing, so these drugs should be used for as short a time as possible. Hormone levels should be checked if you are on morphine or similar for several months.
Codeine is changed in your liver to morphine, so if you take it in large doses, for example co-codamol 30/500, which contains 30mg codeine and 500mg paracetamol per tablet, it has the same short and long term side effects as morphine, and is very constipating.
Tramadol is classified as a strong opioid analgesic. It has a dual effect, which means that it works partly in the same way as morphine, but also through other chemicals in the nervous system. It can be addictive in some people.
It is best to take all pain killers in the lowest dose possible and for as short a time as possible, but you should not be afraid to take them as needed immediately after surgery.
Trauma, surgery and the application of limb frames may stretch or damage fine nerves and give rise to nerve pain, called neuropathic pain. This is associated with a burning, stinging feeling on the skin or sharp stabbing pains which come at any time. There may be numbness, pins and needles or increased sensitivity of the skin to touch, to hot or to cold. This is a normal part of the healing process, but does take weeks or months to settle. The pain team doctors will advise you about drugs such as Gabapentin, Pregabalin and/or Amitriptyline which are used for treating nerve pain. Local anaesthetic skin patches, called Versatis, can sometimes be used on areas of sensitive skin or around the pins.
Physiotherapy and pain
Physiotherapy can help in reducing your pain after your operation and during the treatment period. Exercise and movement, within your pain-controlled limits and as recommended by your Physiotherapist or Consultant, is important to help prevent problems from occurring.
The common problems that Physiotherapy can help with are:
- Muscle contractures and tightness
- Joint stiffness
- Muscle weakness
- Poor mobility and walking pattern
If you are taking painkillers make sure you give them enough time to take effect before doing your exercises. You will be able to move more easily if your pain is well-controlled.
Can I relieve pain without drugs?
Keeping occupied, moving as much as possible, socialising and being with family and friends all help you to cope with pain.
Acupuncture may be helpful but is not recommended until healing of the skin has taken place
Anxiety increases pain. If you have worries, talk them through with someone
If you are becoming depressed don’t be afraid to talk to someone about it.
Depression increases pain, so it is very important to talk about your feelings.
As a result of research through the Kings College Hospital IMPARTS (Integrated Mental and Physical healthcare Research Training and Services) programme, the Limb Reconstruction Unit at Kings has had its long held view confirmed: Patients undergoing reconstruction surgery have a real need for access to psychological counselling. The Trust has therefore paid for the development of a patient psychological support service with the assistance of Consultant Psychiatrist, Matthew Hotopft, of the Maudsley Hospital further details can be found here. Alternatively if you prefer a referral can be made by the orthopaedic doctors to your GP.
There are psychologists available in the hospital who may be able to help, or a referral can be made by the orthopaedic doctors to your GP.