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Pain Control after Heart Surgery

Managing your pain after surgery is a priority for you and your healthcare team. You can expect to have some discomfort, and your doctor and nurses will do everything possible to help you get relief.

The following information will help you understand your pain treatment, describe how you can help your doctors and nurses control your pain, and empower you to take an active role in making choices about pain treatment.

Tell your doctors, nurses and health care providers:

  • If you are taking pain medication at home on a regular basis
  • If you are allergic to or cannot tolerate pain medication.
  • If you have any chronic medical condition (back problems, knee problems, etc.) for which you regularly take pain medication.
Why is pain management so important?

Effective pain management not only helps you feel more comfortable, but also helps you recover faster and may reduce your risk of developing certain complications, such as pneumonia and blood clots. If your pain is well managed, you will be better prepared and able to complete tasks that are important to your recovery, like walking and deep breathing exercises.

As a patient, you have the right to:

  • The best level of pain relief that can be safely provided
  • Information about pain and pain management
  • Healthcare team members who will ask about your pain often, and who will respond with a treatment
What kinds of pain can I expect to feel after surgery?

Every patient is unique, and you may or may not have the same type of pain another patient experiences. You may be surprised after surgery to feel pain in places besides the incision site, especially as you begin to move about. Please tell a member of your healthcare team about the pain you have after surgery, which can include:

  • Muscle pain: You may feel muscle pain in your neck, shoulders, back or chest. This is from lying on your back on the operating table and in the care unit.
  • Throat pain: Your throat may feel sore or scratchy from the endotracheal (breathing) tube.
  • Pain from chest tubes: You may have some discomfort from the chest tubes that were placed in your chest to drain fluid, blood and air during heart surgery.
  • Incision pain: You may feel pressure or burning at the incision site(s)
How is pain rated?

Most importantly, you can help the doctors and nurses” measure" your pain. While you are recovering, your doctors and nurses will ask you to rate your pain on a scale of 0 to 10 with"0" being” no pain" and"10" being” the worst pain you can imagine." Reporting your pain as a number helps the doctors and nurses know how well your treatment is working and whether to make any changes.

Your doctors and nurses want and need to know about any pain that is not under control.

Description, in part, from: McCaffery M, Pasero C. Pain: Clinical Manual, 1999, p 67; Mosby, Inc.


Who is going to help manage my pain in the hospital after surgery?

Your health care team will work with you to decide what type of pain control would be most beneficial for you after surgery.  Your doctors may consult the Cardiothoracic Anesthesia Pain Management Service, which includes Anesthesiologists who specialize in pain control, to help manage your pain following surgery.

The type of pain control that is best for you is based on:

  • your medical history
  • results from your laboratory tests
  • your physical exam
  • the type of surgery you are having or have had

After surgery, you will be assessed daily to make sure that you are comfortable, adjust your therapy if needed, and monitor you for any side effects.

Make sure you are comfortable with your pain management plan. Talk to your doctor and nurses about your concerns and needs. This will help avoid stress and anxiety, which can make pain worse. Do not be afraid to ask questions

There are several different ways to receive pain medication. Depending on your needs, you may have one or more of the following:

Patient-Controlled Analgesia

Patient-controlled analgesia (PCA) allows you to safely receive pain medication by pushing a button, which triggers a pump that delivers small, controlled amounts of the medicine through your intravenous (IV) line or a small catheter in your back. This medication may be delivered either continuously (basal rate) or only when you press the button. Because the amount of medication that is released is controlled, you do not need to worry about giving yourself too much medication. You are the only person allowed to push the button. Do not allow family members or friends to push the button for you.

Intravenous (IV) Pain Medication

This is pain medication that is delivered through your IV. You should feel some relief shortly after it is administered. Although IV pain medication provides quick relief, it is not long-lasting. Intravenous pain medication may be used in combination with oral pain medication. Your nurse will talk to you about how often you can receive the medication(s).

Oral Pain Medication

Oral pain medication is taken by mouth. Because it takes longer for these medications to take effect than those delivered through an IV, it is important to take the medication before your pain becomes unbearable. Oral medications usually provide longer lasting relief. Your nurse will talk to you about how often you can receive the oral medication(s).

Acetaminophen (APAP)
Over the Counter

DayQuil/NyQuil
Excedrin
Midol
Theraflu
Tylenol

Prescription
Darvocet (APAP and Codeine)
Lortab (APAP and Hydrocodone)
Percocet (APAP and Oxycodone)
Tylenol 3 (APAP and Codeine)
Vicodin (APAP and Hydrocodone)

NSAID - Nonsteroidal Anti-inflammatory Drugs (Ibuprofen, Naproxen, Aspirin)
Over the Counter

Advil
Aleve
Bayer
Aspirin
Ecotrin
Excedrin
Motrin

Prescription
Celebrex
Darvon
Ibuprofen
Indomethacin
Mobic
Naproxen
Toradol
Voltaren

* This is not a complete list. There are many more medications that contain these ingredients. Always read the label of your medications and call your pharmacist with any questions.

Side Effects

There are specific side effects associated with every medication. However, common side effects associated with pain medication include nausea, vomiting, itching, drowsiness and constipation. There are medications to help relieve some of the symptoms, or your healthcare team may need to make changes to your medication or the amount you’re taking. Please talk to your nurse and doctor about any side effects you may have and any questions or concerns you have.

Medication is not the only way to relieve pain. It is important to keep an open mind about these techniques. When used along with medication, these techniques can offer a great deal of pain relief.

Guided imagery or relaxation tapes

Relaxation recordings or Guided Imagery is a proven form of focused relaxation that coaches you in creating calm, peaceful images in your mind, a "mental escape." For the best results, practice using the recording before your surgery and then use it twice daily during your recovery. Cleveland Clinic has had great success with this relaxation program.  We provide patients with instructions on how to download these programs onto their personal MP3 players or CDs are available.

You can also get relaxation tapes at bookstores; rent them at the library, and on site at several stores. Some people also benefit from listening to relaxing music. So, along with your guided imagery programs, use music to relax and relieve tension and pain.  Learn more about guided imagery

Heat or cold therapy

At home, heat or cold therapy may be an option that your surgeon may choose to help with pain. Specific instructions for the use of these therapies will be discussed with you by the surgical team.

Massage Therapy

Massage is used to support your medical condition, aid recovery from procedures, manage pain, decrease muscle tension and promote relaxation to help you cope with your hospital stay. Massage therapy is proved at Cleveland Clinic by licensed massage therapist who have been specifically trained in hospital based manual therapies. If you want to continue massage at home, talk to your health care team about restrictions in position.

Pillows

If you have an abdominal or chest incision, you will want to splint the area with a pillow when you are coughing or deep breathing to provide support for your incision. You will be given a pillow in the hospital. Continue to use it at home when needed.

Surgical bras and vests
  • Women may wear a surgical bra for comfort. Often, the incision site is pulled by the weight of the breasts when lying down. The surgical bra helps avoid that discomfort. Some women may find their own bra may be more comfortable.
  • Large men may feel more incision support with a surgical vest.
  • Ask your nurse if you are interested in a surgical bra or vest.

Note: While you are in the hospital, Cleveland Clinic offers a variety of complimentary services to help improve your well-being and enhance your pain management and healing:

  • The Relaxation channel (Channel 36) on your hospital television offers a variety of music and relaxation programming, including guided imagery
  • The Healing Services team offers a variety of services including massage and reiki therapy that can help reduce pain and increase your comfort level and recovery.
  • Music and art therapy is available to help you heal and recover. The Arts & Medicine Institute offers a variety of programs designed to promote wellness and healing.

If you are interested in these onsite programs, ask a member of your healthcare team for more information.

Here are tips for managing your pain at home:

  • Before you leave the hospital, discuss with your nurse how often you have taken the pain medication while in the hospital. You should find that you require the same or less medication the first 2 - 3 days at home.
  • Take your medication as prescribed. Your healthcare provider has ordered your pain medication “PRN” or “as needed.” This means that you take the medication if and only when you need it to treat moderate to severe pain.
  • Keep a record of when you are taking the medication at home. It is important to write down the time you take each dose to safely space out the medication.
  • Keep track of how much medication you have. If you require narcotic pain medications, look at your pill bottle and make sure you are not going to run out over the weekend or in the evening. Talk to your doctor and plan ahead. Remember: narcotic pain medication prescriptions cannot be called or faxed to your local pharmacy – you require a formal prescription.
  • After the first few days at home, you should start weaning off the narcotic pain medication. Try to take less each day, by waiting longer in between doses or taking only 1 pill at a time instead of 2 pills – or taking the stronger medications at night and over-the-counter mediations during the day.
  • The most common side effects of narcotic pain pills include:
    • Constipation: Monitor your bowel movements. Take over-the-counter laxatives or stool softeners such as Milk of Magnesia or Colace and increase your intake of high fiber foods to avoid constipation.
    • Drowsiness and dizziness: Do not drive while taking any narcotic pain pills.
    • Nausea and vomiting: Take the medication with food to avoid nausea and vomiting.
  • Use other medications to treat your pain: Over-the-counter pain medications, such as acetaminophen and NSAIDS, are an excellent option to treat pain. Be sure your doctor has approved you to take certain medicines. You must be careful to not take too much of any one medication. Always read the labels, and never take more than 1 medication in the same category. For example, you may take Percocet with Motrin (NSAIDs), but do NOT take Percocet with Tylenol.
  • Use other methods to treat your pain: Heat and ice, relaxation techniques, position changes, and guided imagery have been proven to significantly help with pain control. These methods also have the added benefit of not having any side effects. The combination of these alternative methods and medications will provide you with the best pain relief possible.

If your pain is not improving, or you are alarmed about your pain worsening, always call your doctors office to discuss your pain concerns.

Reviewed: 08/12

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.

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