📕 Beyond the Incision – Why You Shouldn’t Just “Tough It Out” After Surgery

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♦️ Introduction

Picture this: it’s postoperative day one after major abdominal surgery. Despite receiving opioids, your patient rates their pain as 7 out of 10 ⚡️. They can’t take deep breaths or get out of bed because it hurts too much 😣.

Ignoring this isn’t just about discomfort or asking patients to endure it—it carries real risks of preventable complications.

Uncontrolled acute pain isn’t limited to local discomfort. It’s a systemic physiological stressor that affects the entire body. Effective pain management isn’t only about comfort—it’s essential for preventing systemic complications, shortening hospital stays, and avoiding long-term disability ☝️.

♦️ Cardiovascular and Respiratory Impact

Severe pain triggers a surge in sympathetic nervous system activity. For a patient who should be recovering, this is a dangerous, full-blown “fight or flight” response.

♦️ Immune and Endocrine Dysfunction

Pain doesn’t just affect comfort or breathing—it triggers a cascade of hormonal and immune responses. The same sympathetic surge activates the hypothalamic-pituitary-adrenal (HPA) axis, flooding the body with stress hormones like cortisol.

Here’s what happens—and as you’ll see, leaving postoperative pain uncontrolled offers no benefit 😓:

⚡️ The Acute-to-Chronic Pain Transition

Most people think postoperative pain is purely an acute-phase issue. Usually, that’s true—but poorly controlled acute pain can evolve into chronic pain 😖. Chronic postsurgical pain (CPSP) affects approximately 10–20% of surgical patients and can persist for months or even years.

One of the strongest predictors? The intensity of pain during the first 48–72 hours after surgery. Multiple studies confirm that early pain intensity strongly influences whether chronic pain develops later.

The mechanism is central sensitization—the nervous system continues to amplify pain signals even after tissues have healed.

💡 Key Point: Control pain aggressively during the first 24–72 hours. This isn’t just for comfort—it helps prevent neuroplastic changes in the spinal cord and brain that perpetuate pain.

☝️ The Solution: Proactive Multimodal Analgesia

Given these risks, relying solely on opioids isn’t sufficient. Major guidelines from the ASA, APS, and ASRA emphasize proactive multimodal analgesia as the standard of care.

So, how does it work? Think of it as targeting pain from multiple mechanisms simultaneously

🌐 International Note
While multimodal analgesia is widely practiced globally, some medications (such as IV ketamine for postoperative or chronic pain) may still be considered off-label in certain countries, including Japan. Always follow your institution’s protocols and local regulatory standards.
Gabapentinoid administration for preoperative pain prevention may also be off-label in some regions. For example, while pregabalin is approved for neuropathic pain in Japan, its use for postoperative pain prevention may require ethics committee approval or off-label use procedures. Informed consent is essential.

✅ The Benefit

This multimodal strategy delivers superior pain relief while reducing opioid consumption by approximately 30–40%. Less opioid means fewer side effects—less respiratory depression, sedation, nausea, and ileus—leading to shorter hospital stays and faster overall recovery 👍.

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📝 Summary: Take-Home Messages

Postoperative pain isn’t just a symptom—it’s a stressor that profoundly affects the heart, lungs, and immune system. Proactive management with multimodal strategies is essential for preventing complications and chronic pain.

🔑 Key Points

📚 References & Further reading

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