What is Transitional Pain?
Pain the Patient Takes Home
Transitional pain refers to the pain that occurs during the recovery period following surgery, as the body transitions from acute pain – typically related to the surgical procedure itself – to a more stable state where healing begins and pain levels start to decrease. This transitional phase can be characterized by:
- Intensity Fluctuation: Pain may vary in intensity as the body heals, often requiring adjustments in pain management strategies.
- Duration: This type of pain can persist for days to weeks after surgery, depending on the individual, the type of surgery and other factors.
- Types of Pain: It can include both nociceptive pain (tissue damage) and neuropathic pain (nerves damage), and patients may experience sensations such as aching, sharpness or throbbing.
- Impact on Recovery: Effective management of transitional pain is crucial for a smooth recovery process, as uncontrolled pain can hinder mobility, lead to complications and affect overall well-being.
- Management: Treatment may involve a combination of medications (like opioids, non-steroidal anti-inflammatory drugs, and adjuvant therapies), physical therapy and other supportive measures.
Understanding this phase helps both patients and healthcare providers to optimize pain control and enhance recovery.
Understanding the Risk of Opioid Addiction After Surgery
Recent data indicates that the risk of developing opioid use disorder can begin within the first 72 hours after surgery. Early exposure to opioids post-operation increases the likelihood of persistent use and potential addiction.
As the duration of opioid use increases, so does the risk of long-term use:
- 2X more like to continue opioid usages when taking opioids for 5-7 days
- 3X more likely to continue opioid usage when taking opioids for 7-11 days
Opioid prescription refill rates contribute to the potential for long-term opioid usage. Rates of long-term usage can increase after just the second prescription refill.
Transitional Pain Is an Important Part of the Post-Surgical Recovery Process
Because patients take several weeks to months to recover after cardiothoracic surgery, transitional pain is an important part of the recovery process from a pain management perspective.
Cardiothoracic surgery patients can be in significant pain for a long period of time following surgery. Patients can take several weeks or months before they have greater than 80% recovery from their pain symptoms. Cardiothoracic surgery is painful with long recovery periods due to the invasive nature of the procedure.3
Transitional pain begins when the patient leaves the hospital. Lasting until the patient recovers from surgery, or until the onset of chronic pain at 3 months.2
Transitional Pain, if Not Managed Correctly, Can Be a Precursor To Chronic Pain
Post-surgical pain that is not managed or controlled effectively can lead to chronic pain.
Prevention of chronic pain begins with the surgical procedure and continues throughout the transitional pain period. Effective pain management during the first 3 months following surgery can be an effective strategy in limiting the onset of chronic pain.4-5
Post-Surgical Pain Management
When patients are recovering from surgery in the hospital setting, there are more options available from anesthesia or nursing providers for pain management.
Upon leaving the hospital, options for pain management decrease and leave the patient with minimal options to treat their transitional pain.
Patients have limited options for pain management upon leaving the hospital.
In-Hospital Pain Management
- Epidural
- Para–vertebral block
- Patient–controlled analgesia (PCA)
- Regional blocks
- Local blocks
- Oral medications
- Nurses/support
- Acute pain service
- 24/7 care
At Home Pain Management
- Oral medication
- Topical solutions
- Rest, Ice, Compression, Elevation (RICE)
Recovery and the Impact of Transitional Pain
Patient movement following surgery has been shown to improve recovery and decrease time to return to normal function. One of the limiting factors in getting patients to move is pain.
Cryo Nerve Block Therapy offers a unique approach to managing transitional pain by temporarily freezing the intercostal nerves, reducing post-operative pain and allowing for easier movement as the surgical area remains numb for several months.
“Pain does not have to be part of surgical recovery, minimizing pain will enhance recovery.1 ”
– Dr. David Caparrelli
Learn More About Cryo Nerve Block
Measuring Functional Pain To Understand Transitional Pain
Before evaluating transitional pain, it’s crucial to measure functional pain. Functional pain provides insight into how pain affects an individual's daily activities and quality of life, moving beyond the traditional pain scores.
Quality-of-life assessments help identify the impact of pain on their physical and emotional well-being, guiding targeted intervention and improving overall management strategies. Additionally, understanding functional pain can enhance communication between patients and healthcare providers, fostering more personalized treatment approaches.
Assessing Functional Pain Scores
Pain scores can vary based on activity but often pain scores are evaluated during non-movement activities. Looking at pain during ambulation/activity, otherwise known as dynamic pain, can be insightful to evaluate the effectiveness of pain management and recovery from surgery.
Static Pain Scores: Pain evaluation devoid of movement or activity
Dynamic Pain Scores: Evaluation of pain during movement or specific activity. (Walking, Incentive Spirometery)
References
- CMC pioneers ‘almost painless’ approach: Cardiac surgery without opioids. New Hampshire Union Leader, Catholic Medical Center, Aug 15, 2021. https://www.unionleader.com/news/health/cmc-pioneers-almost-painless-approach-cardiac-surgery-without-opioids/article_1b0e57d8-0660-5fe9-aa94-5954fc67787a.html.
- Schug, S.A. et al. (2019). The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. PAIN, 160(1):45-54.
- Fagundes, C.P. et al. (2015). Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory. J Thorac Cardiovasc Surg, 150(3):613–9.
- Blichfeldt-Eckhardt M.R., Andersen, C., Ørding, H., Licht, P.B. & Toft, P. (2018). From acute to chronic pain after thoracic surgery: the significance of different components of the acute pain response. J Pain Res, 11:1541-8. doi: 10.2147/JPR.S161303. PMID: 30147358; PMCID: PMC6101742.
- Gan, T.J. (2017). Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res, 10:2287-98. doi: 10.2147/JPR.S144066. PMID: 29026331; PMCID: PMC5626380.
*discharge from hospital
