5.5.2 Pain as a Consequence of Operation

Surgical procedures can cause several different forms of pain, including incisional pain. Depending on the resection and the specific tissues removed, patients may experience deep wound pain that may be more difficult to control. Finally, many patients may experience a variety of chronic pain syndromes after surgery (See Table 5). Some of these may not emerge until weeks or months after discharge. The surgeon should recognize and treat characteristic pain syndromes that follow specific surgical procedures (e.g., mastectomy, nephrectomy, etc.).

Careful surgical technique frequently can ameliorate the severity of postoperative pain. Gentle tissue handling; use of nerve- or vessel-sparing procedures; avoidance of tissue ischemia; careful neurolysis, as needed, performed with a dissecting microscope; and selection of non-muscle-splitting incisions can contribute to less painful surgery and recovery.

In the postoperative period, the surgeon should encourage the full use of the pain-control armamentarium. The management of patients with acute pain such as that caused by pathologic fracture, surgery, or diagnostic treatment procedures is described in detail elsewhere (Acute Pain Management Guideline Panel, 1992).

The surgeon should assess the quality of postoperative pain control by frequent, direct patient contact. The surgeon without expertise in pain management should seek consultative help, particularly for the treatment of special populations. An integrated multidisciplinary pain control approach will maximize the usefulness of surgery as an adjunct of pain control in the patient with cancer.

Related Chunks

PlexoPathies

Peripheral Neuropathies

Abdominal Pain

Assessment of New Pain

Constipation

Influence of Concurrent Medical Conditions on Pharmacotherapies

Neurosurgery

Surgical Management of Pain due to Primary or Metastatic Tumor

Index