- What is the VAS scale, and how do I use it when explaining my level of pain to the staff?
- How much pain should I expect with my surgery?
- How long does it take for PCA (Patient Controlled Analgesic) or pain pills to start working? How long does each last?
- How do I get my pain relief pills while in the hospital?
- What pain medications (pills) are most commonly prescribed?
- How long will I be on pain medication?
- What are the side effects of the pain medications?
- Will I become addicted to the pain medications?
The VAS (Visual Analog Scale) is a horizontal line with "no pain" written at one end and "unbearable pain" written at the other. Between the two options are a series of numbers from 0 (no pain) to 10 (unbearable pain). Based on what you feel as your level of pain on the 0 to 10 scale, you will inform the nurse of this number, and pain medication will be given accordingly. The VAS scale is an important tool that we use here at HSS. Since pain is different for each and every person, only you are able to tell us exactly what you are feeling. The number you give to rate your pain is important because it helps the staff know whether the pain medication you are getting is working well enough to keep you comfortable. A “comfortable” number is usually a VAS score of 3-4. Here is an example of the VAS scale:
No matter what surgery you are planning to have, you WILL experience some discomfort/pain. Because no two people are alike, the amount of pain you feel will be a completely personal experience. No matter what level of pain you have following your surgery, the Pain Management team will work hard to get your pain under control. Unfortunately, we are unable to completely eliminate your pain - only time and healing will do that - but generally, a pain level of 3-4 on the VAS or less (see above FAQ) is tolerable and will allow you to perform physical therapy and daily activities with minimal limitations. Keeping you in this range is our goal in pain management and we will make every effort to keep you comfortable and get you moving toward recovery.
Generally, after pushing the button on the PCA, initial relief of discomfort can begin in as little as five minutes. The PCA medication kicks in quickly, but usually lasts for only a few hours – a much shorter time period than oral pain pills. Oral pain pills dissolve in the stomach and take between 30-45 minutes to start working from the time they are swallowed. Because these pills dissolve slowly in the stomach, they generally work to control pain for 3-4 hours at a time.
Regulations allow for oral pain medications to be ordered for patients on an “as needed” basis. Pain medications are NOT distributed automatically by our staff. This means that each patient is responsible for asking for their pain medications at scheduled times throughout the day or when experiencing an increase in pain. Your assigned nurse will routinely check your pain status throughout your stay at HSS, but it is important that you keep track of your pain medication and ask for it every 3-4 hours in the immediate period following your surgery. This will ensure that you are more comfortable throughout the entire day.
The most common pain medications in pill form used at HSS are Vicodin or Norco (hydrocodone/acetaminophen) and Percocet (oxycodone/acetaminophen). Depending on your pain level, both can be quite efficient with few side effects. It is common to be started on one of these medications and then changed onto another.
Generally, our patients are on pain medication for a few weeks; since everyone progresses at a different pace, there is no exact timeframe. Most patients find that they take their pain pills more often throughout the days of their first and second weeks of recovery. After some healing time and physical therapy, patients typically require less frequent dosing, eventually stopping the pain medication at about 4-6 weeks after surgery.
The most common side effects of pain medications are:
Most of these side effects are mild and can easily be controlled with medications while here at the Hospital. A rash is NOT an expected side effect and may be an indication that you are allergic to the medication you are taking – if this happens, please tell your doctor or hospital staff (RN) immediately.
It is very rare that patients become addicted to pain medications following their surgery. Though long term use (many weeks to
months) may increase your risk of getting accustomed to a current dose of medication so that you require an increased dose in order to experience pain relief, most patients undergoing routine orthopedic surgery only need pain medications for a short time. The risk of dependence or addiction, therefore, is quite low.
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Reviewed by Philip J. Wagner, MD