Pain management before and after neurosurgery is a challenge for most doctors. In this study, pain patterns are described for different kinds of brain and spine operations. Understanding pain patterns may be the first step before pain therapy can be determined.
Data on pain patterns before and after surgery was collected for 649 neurosurgery patients. Neurosurgery included any operation on the skull or spine. Patients were asked about pain location, frequency, intensity, and duration. Researchers compared patients with and without complications. Pre- and postop pain patterns were described.
Patients also reported on local versus referred pain. Local pain occurs at the site of the operation. Referred pain is felt some distance away from the cause.
Results from this study showed that pain didn’t depend on gender. In other words, pain intensity wasn’t linked with whether the patient was male or female. Age did seem to make a difference. Younger patients had less pain before surgery and more pain after the operation compared to patients 60 years old and older.
Problems after surgery such as infection or delayed healing usually resulted in more pain. As expected, pain levels went down after surgery as time went on. Operations on the skull tend to have less pain than spinal surgery. Most patients having spine surgery expected more pain relief after the operation than they actually got. Patients who had pain before the operation had more postoperative pain compared to patients who didn't have pain before.
The authors offer several guidelines for managing pain after neurosurgery. Nurses and doctors should be aware that these operations are more painful than expected by the patient. Drugs for pain should be given on the first day after the operation for most neurosurgeries. Some patients will need more intense drug therapy after that.
Pain should be treated seriously in all patients. But both patients and health care workers shouldn't be surprised if the pain relievers don't reduce pain levels. Stronger pain meds may be needed. Patient-controlled analgesia (PCA) is a good option for some patients.
Markus Klimek, MD, DEAA, et al. Pain in Neurosurgically Treated Patients: A Prospective Observational Study. In Journal of Neurosurgery. March 2006. Vol. 104. No. 3. Pp. 350-359.'