Pain relief can fall short after gynecologic surgery

NEW YORK (Reuters Health) - For some women having a hysterectomy or other gynecologic surgery, at-home plans for pain relief may not be good enough, according to a new study.

Of 127 women who had their surgeries at one Utah medical center, about half told researchers their pain control was falling short three days after leaving the hospital.

Two weeks later, 23 percent of women whose surgery had involved cutting into the abdomen were still feeling their pain wasn't controlled -- as were five percent of those who had vaginal surgery.

Even more were still in need of narcotic painkillers at the two-week mark: one-third of women who'd had abdominal surgery, and 10 percent of those who'd had vaginal surgery.

The study, reported in the journal Obstetrics & Gynecology, is a rare inquiry into how women fare during at-home recovery from gynecologic surgery.

?It's just amazingly understudied," said lead researcher Dr. Ingrid Nygaard, of the University of Utah School of Medicine in Salt Lake City.

One reason it's so important to understand what goes on during home recovery is that hospital stays are now much shorter than they were years ago.

The women in this study were discharged from the hospital an average of one or two days after surgery, depending on whether it was vaginal or abdominal. Most often, the surgery was a hysterectomy (removal of the uterus) or a procedure to correct prolapse -- when weakened tissue in the pelvis allows one or more organs to protrude into the vagina.

All of the women kept diaries at home to record their pain control after surgery.

Based on the results, Nygaard's team concluded pain relief was ?suboptimal" for some women.

?I'm not advocating more narcotics," Nygaard said, referring to the powerful painkillers, like hydrocodone and oxycodone, that surgery patients typically need for a period of time after their procedures.

But, she said, there's a need for more research into how to best control women's pain after gynecologic surgery.

?We can see that it's a problem. Now we need to see what helps," Nygaard said.

For now, better patient education on pain control might make a difference, she said. Some women, for example, might find that it's best to take non-narcotic painkillers -- namely, non-steroidal anti-inflammatory drugs like ibuprofen -- ?round-the-clock," and save narcotics for more-occasional use.

Attention to relieving constipation could help too, Nygaard said.

Many patients have constipation after surgery, and narcotics tend to make the problem worse. Having smaller meals, eating more fiber or getting light exercise might help get the bowels moving -- and ease any pain from the constipation, Nygaard said.

In theory, ?complementary" remedies like massage or gentle stretching exercises could also help, she noted. But there's still a need for studies to show whether that's actually the case.

How do you know if your discomfort after surgery is ?normal" or not?

According to Nygaard, one ?red flag" is if you're still in need of narcotics after two weeks. But each patient has to talk with her own doctor about the best way to manage her pain.

One ?striking" finding from the study, Nygaard noted, is that about half of the women said they still did not feel generally ?recovered" six weeks after surgery.

So if you're still not feeling yourself at that point in recovery, you're not alone. ?It's not abnormal to not feel fully recovered at six weeks," Nygaard said.

SOURCE: http://bit.ly/IiQLma Obstetrics & Gynecology, April 2012.

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