Acute Pain can be severe but usually gets better quickly. Your anaesthetic/surgical team will decide which tablets are suitable for you following your surgery. You have been given this leaflet to provide you with information about tablets you are taking and general advice on getting the most out of your pain relief and management of side effects.

Pain relief following surgery

To assess how effective the pain medication is at relieving your discomfort, we will discuss with you the level of pain after surgery by asking you to score your discomfort on a 0-10 scale. 0 = no pain whilst 10 = worst pain ever experienced. Pain scales make pain measurable, and can tell us whether your pain is mild, moderate or severe. We can then make sure the pain medication is appropriate for you. If there was no change, or if the number increased, then we know it is time to try something else.

How often do I need to take pain killers?

Pain is much harder to control if you let it build up so that it is unbearable. We recommend that you take your pain medication such as Paracetamol and a Non-Steroidal Anti-Inflammatory Drugs (NSAID) regularly for the first 48 hours, and then as required depending on your comfort levels. All your pain medication will have a label on, to tell you how often to take them. Never take more tablets per day than the label says. Most pain medication takes from 30-60 minutes to start working when taken as a tablet.

Why have I been given several pain killers?

One type of pain medication may not be enough to control your discomfort. The pain medications you have been given all work in different ways and so can be used at the same time. The combination of tablets should provide you with superior pain control and reduced side effects than if the tablets were used on their own. The amount of pain medication can be reduced as healing occurs.

Pregabalin (nerve pain killer)

Pregabalin is given at the discretion of your anaesthetist and it is used to control persistent pain. It is especially good for nerve type pain and works by changing the way that nerves send messages to your brain. If the messages are reduced then the pain will be reduced. Some patients may occasionally experience side effects such as dizziness at rest or moving, blurred vision, headache, dry mouth, drowsiness, feeling or being sick, hallucinations.

Other medications you may be given:

Ondansetron 4mg tablet

Take 1 tablet 8 hourly or as directed if feeling sick or nauseated. Some side effects can be flushing, headaches and constipation.

Constipation

Opioids may cause constipation, made worse by a reduction in mobility after your surgery, which could lead to slowing down of your bowel.

Lactulose

Take 10mls once or twice a day; this is given to reduce the risk of constipation, softening your stool, making having a bowel motion easier.

Senna 7.5mgs

Take 1 or 2 tablets at night, this is a mild stimulant to reduce the risk of constipation whilst taking the pain medication.

Cautions with medications

Some pain medications can cause drowsiness, therefore affecting the ability to drive or operate machinery. Do not drive until you know how the medicine affects you. More information on the medication that has been prescribed for you can be found in the medication packaging please read and follow this information.

Medication

Paracetamol 500mg tablets

Paracetamol is a simple, yet effective pain medication if taken regularly. Take 2 tablets four times a day, regularly for the first 48 hours and then take 2 tablets every 4-6 hours as required depending on how severe the discomfort is. DO NOT take more than 8 tablets in 24 hours. You must not take any other medicines that contain Paracetamol at the same time. These include Cocodamol, Codydramol, and some cold and flu remedies. Paracetamol can be bought at your local pharmacy without a prescription. Side effects are rare but can include rashes.

Non-steroidal anti-inflammatory (NSAID)

Ibuprofen 400mgs up to three times daily to a maximum of 1200mg in 24 hours , Naproxen 500mgs twice a day to a maximum 1000mg in 24 hours, Diclofenac 50mgs three times daily to a maximum 150mgs in 24 hours, and Etoricoxib maximum 120mgs once a day.

This is used to treat mild to moderate pain. It works by reducing the swelling and inflammation caused by surgery. You take this medication with or after food to prevent indigestion symptoms. You may be prescribed Omeprazole 20mg capsule once a day to help prevent and reduce the risk of gastric ulcers associated with the use of non-steroidal anti-inflammatory drugs (NSAID).

Do not take more than one anti-inflammatory at any one time. These tablets can be taken in addition to Paracetamol, Codeine, Tramadol and Morphine.

If you have asthma, history of stomach ulcer or problems with your kidneys, these medications may be unsuitable for you. Some of the common side effects are upset stomach, feeling sick, diarrhoea.

Opioids

Opioid medications are useful for treating acute pain and usually only need to be given for a period of a few days. Opioids provide pain relief by acting on areas of the spinal cord and brain to block the transmission of pain signals. Opioids are considered to be some of the strongest pain medications available and are used to treat pain after surgery.

Codeine Phosphate 30mg tablets (mild opioid).

This is a stronger pain killer. You should continue to take Paracetamol regularly in addition to these. Take 1 or 2 tablets four times a day regularly for the first 48 hours and then take 1 or 2 tablets every 4-6 hours as required depending on how severe the pain is. DO NOT take more than 8 of these tablets in 24 hours. (You must not take any other medicines that contain Codeine at the same time. These include: Cocodamol, and Codydramol, and some cold and cough remedies).

Cocodamol 30/500mg tablets (Codeine and Paracetamol)

You may be given a tablet that contains both Paracetamol (500mg) and Codeine (30mg). Take 1 or 2 tablets four times a day regularly for the first 48 hours and then 1 or 2 tablets every 4-6 hours as required depending on how severe the pain is. DO NOT take more than 8 tablets in 24 hours. (You must not take any other medicines that contain Paracetamol or Codeine at the same time as these tablets).

Tramadol Hydrochloride 50mg tablets (moderate opioid) 

This is given for moderate to severe pain and acts by blocking pain  messages from the spinal cord to the brain but also at the surgical site.  Take Tramadol Hydrochloride 50mg capsule 1 or 2 capsules up to four  times a day to a maximum of 400mg in 24 hours for the first 48 hours  and then take 1 or 2 capsules every 4-6 hours as required depending on  how severe the pain is. DO NOT take more than 8 capsules in 24 hours. Some of the common side effects are feeling light headed, drowsiness,  feeling or being sick, constipation, dry mouth, itchy skin, hallucinations. 

Oral Morphine solution (Oramorph)(strong opioid) 

This is a liquid Morphine solution, for use when your pain is not controlled  by the painkillers already mentioned and is used when quick and speedy  pain relief is required, for example before physiotherapy, or if other pain  tablets are not due and you are experiencing pain. It is a strong pain killer. Take 5-10mls (10-20mg) as required, every 2-3 hours until your pain  is controlled.  

Oxycodone Hydrochloride Modified Release tablet (strong opioid) 

This is a morphine tablet used to treat severe pain and is used when  your pain is not controlled by the pain medication mentioned above. This  tablet provides 12 hours of pain relief and is given in the morning and at  night. You are usually given four doses only (lasting two days) after  your operation.  

Oxycodone Hydrochloride Immediate Release capsule  (strong opioid) 

This morphine capsule is used when quick and speedy pain relief is  required, for example before physiotherapy, or if other pain tablets are  not due and you are experiencing pain. Take 1 capsule as directed, 1-3  hourly until your pain is controlled.