Pain After Surgery: Multimodal Relief and the Alternatives to Opioids

The first question on the pre-op checklist used to be about fasting. Lately, a different one comes up in the consultation room before the surgeon has finished explaining the incision: “Can I do this without opioids?” Search interest in pain after surgery has climbed sharply since January 2025, when US regulators approved suzetrigine (Journavx), the first new class of non-opioid pain medicine for acute pain in more than two decades. Headlines called it a breakthrough. Social feeds called it the end of opioids. Neither is quite right.

As of spring 2025, the honest picture is more interesting than either claim. The real shift in recovery rooms is not one new tablet but a philosophy called multimodal analgesia, which stacks several modest-strength tools so that no single one has to do the heavy lifting. It has been quietly rewriting surgical protocols for a decade.

This explainer walks through what hurts, when it peaks, what the evidence supports, and where the alternatives to opioids genuinely stand.

What changed recently in how pain after surgery is treated

Three dated developments explain why this topic is suddenly everywhere.

The first is regulatory. On January 30, 2025, the US Food and Drug Administration approved suzetrigine, a medicine that blocks a sodium channel called NaV1.8, which is found almost exclusively on pain-sensing nerves outside the brain and spinal cord. Because it does not act on the brain’s opioid receptors, it carries no known risk of euphoria or dependence. It is the first truly new mechanism for acute pain since the COX-2 inhibitors arrived around 2000.

The second is guidance. In November 2022, the Centers for Disease Control and Prevention published its updated Clinical Practice Guideline for Prescribing Opioids for Pain. For acute pain, the kind that follows an operation, the guideline states that non-opioid therapies are at least as effective as opioids for many common painful conditions and should be maximized first. When opioids are used, it recommends immediate-release forms, the lowest effective dose, and a supply matched to the expected duration of pain, which for most procedures is a matter of days rather than weeks.

The third is cultural and harder to date. Enhanced Recovery After Surgery programs, often shortened to ERAS, have become standard in colorectal, orthopedic and gynecologic surgery. These are structured pathways that combine pre-operative education, early eating, early walking and opioid-sparing analgesia. Hospitals that adopted them reported shorter stays and lower opioid use in observational audits, which in turn made patients and surgeons comfortable asking for less.

Put together, a new medicine, a clearer guideline and a decade of protocol change have moved opioid alternatives from a niche request to the default conversation before an operation.

What does multimodal pain relief actually mean?

Multimodal analgesia is the practice of combining two or more pain treatments that work through different mechanisms, so each can be used at a gentler level. The analogy anesthesiologists often reach for is a sound mixing desk: rather than pushing one fader to maximum, you bring up several a little.

Pain after surgery travels along a chain. Damaged tissue releases inflammatory chemicals such as prostaglandins. Those chemicals excite peripheral nerves, which carry the signal to the spinal cord, where it is amplified or dampened before reaching the brain. Each link is a place to intervene.

• At the tissue: anti-inflammatory medicines reduce prostaglandin production; cold packs constrict blood vessels and slow swelling.
• At the nerve: local anesthetics injected around a nerve, called a nerve block, stop the signal from traveling at all for hours to days.
• At the spinal cord: acetaminophen appears to act partly here, and medicines such as ketamine blunt the “wind-up” that makes repeated signals feel worse.
• In the brain: opioids change how pain is perceived, and so do sleep, distraction and expectation.

The practical result is a schedule rather than a single rescue pill. A typical plan involves a long-acting anti-inflammatory and acetaminophen given at fixed times, whether or not pain is present at that moment, because staying ahead of pain is easier than catching up. A nerve block placed in the operating room covers the first and worst stretch. Opioids are prescribed only for pain that breaks through that foundation.

Randomized trials comparing combination regimens against single agents consistently show lower pain scores and fewer opioid-related side effects such as nausea and constipation. That is the strongest evidence base in this whole topic, and it is why multimodal relief is now written into mainstream guidance rather than treated as an optional extra.

When does pain peak after surgery?

For most operations, pain is at its worst in the first 24 to 72 hours and then declines day by day. This curve is predictable enough that anesthesiologists plan around it.

Several processes drive the peak. The local anesthetic infiltrated into the wound, and any nerve block placed during the procedure, wears off somewhere between 6 and 36 hours later, depending on the agent used. Inflammation, the body’s repair response, builds over the same window and typically crests around day two or three. Swelling tightens tissue around the incision, and muscles that were stretched or cut go into protective spasm.

The shape of the curve varies by surgery. After a laparoscopic gallbladder removal, many people describe the second day as the hardest and feel markedly better by day four. After a knee replacement, the steepest improvement comes in the first week but meaningful soreness can continue for six weeks or more as the joint is rehabilitated. After a thoracotomy, where the chest wall is opened, pain with deep breathing lingers longer because every breath moves the healing tissue.

Knowing the expected curve matters for two reasons. It sets realistic expectations, which observational studies link to lower pain intensity and lower opioid use. It also tells you when something is off. Pain that is still climbing on day four, or that eases and then returns sharply, does not fit the normal pattern and deserves a call to the surgical team.

A useful question to ask before the operation is: “On which day do your patients usually feel the worst, and what should I expect by the end of the first week?” Surgeons who perform the same procedure hundreds of times can answer with surprising precision.

Is it normal for your whole body to hurt after surgery?

Yes, within limits. People are often surprised that the incision is not the only sore spot. Shoulders, neck, back and thighs can ache for a few days, and there are ordinary explanations for most of it.

Position is the biggest one. Under general anesthesia the body is completely relaxed and cannot shift to relieve pressure, so lying still on a firm table for two or three hours loads joints and muscles in ways you would never tolerate awake. Arms may be positioned out to the side or tucked; the head may be turned. The result feels like a bad night on a floor.

Some muscle-relaxing medicines used during anesthesia, particularly a short-acting one called succinylcholine, cause tiny muscle twitches as they take effect and can leave diffuse muscle soreness, called myalgia, for a day or two afterward. This is well documented in anesthesia literature and is harmless.

Laparoscopic surgery adds a specific quirk. The abdomen is inflated with carbon dioxide gas to create working space. Residual gas irritates the diaphragm, and the diaphragm shares a nerve pathway with the shoulder, so people feel referred pain in the shoulder tip. Walking helps the gas disperse.

Beyond mechanics, surgery provokes a systemic inflammatory response. Cytokines, the signaling proteins of the immune system, circulate for several days and produce the achy, feverish, flattened feeling familiar from a viral illness. Dehydration from fasting and blood loss, and the stiffness of a day spent in bed, add to it.

What is not normal: severe pain in a single calf, especially with swelling or warmth, which can signal a blood clot; chest pain or breathlessness; or whole-body pain accompanied by a high fever, chills or confusion. Those patterns need urgent assessment rather than reassurance.

Acetaminophen and NSAIDs: the foundation of non-opioid relief

Two medicine classes do more of the work in modern post-surgical pain plans than most people realize.

Acetaminophen, known as paracetamol outside North America, is a mild-to-moderate pain reliever that works mainly in the central nervous system. On its own it reduces pain scores modestly. Combined with an anti-inflammatory, it performs far better: a systematic review of randomized trials found that the pairing relieved pain more effectively than either medicine alone in the large majority of studies. It is gentle on the stomach and kidneys, which is why it is given on a fixed schedule in most multimodal plans. The main caution is the liver. Many combination opioid products and cold remedies also contain acetaminophen, so the clinician needs to know everything you are taking.

Non-steroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen, naproxen and the injectable ketorolac, block the COX enzymes that make prostaglandins at the site of injury. Randomized trials and Cochrane reviews show they reduce opioid requirements after surgery by roughly a fifth to a third and lower rates of nausea and sedation. Celecoxib, a selective COX-2 inhibitor, spares the stomach lining somewhat.

NSAIDs are not for everyone. They can strain the kidneys, particularly in people who are dehydrated or already have reduced kidney function, raise the risk of stomach bleeding, and in longer-term use are linked to cardiovascular events. Some surgeons avoid them after certain bone fusions or bowel connections because of a theoretical effect on healing, although the evidence for that concern is mixed and mostly observational. A history of heart disease, ulcers, kidney disease or blood thinners changes the calculation.

Which of these you receive, in what form and for how long, is a decision for the anesthesiologist and surgeon who know your medical history. The principle is simple: these two classes together are the floor on which everything else is built.

Nerve blocks for surgery pain: stopping the signal at the source

A nerve block is an injection of local anesthetic placed next to a nerve or group of nerves so that the region they supply goes numb. Guided by ultrasound, the anesthesiologist can see the needle, the nerve and the spreading medicine in real time, which has made blocks far more reliable than they were twenty years ago.

Blocks come in several forms. A single-shot block delivers one dose that lasts roughly 8 to 24 hours depending on the drug. A continuous block threads a thin catheter alongside the nerve and connects it to a small pump that infuses anesthetic for two or three days, sometimes at home. Spinal and epidural anesthesia are blocks placed near the spinal cord and are widely used for cesarean births, hip and knee replacement, and major abdominal operations. Newer “plane” blocks deposit anesthetic between muscle layers of the chest or abdominal wall and cover incisions without numbing a whole limb.

The evidence is strong where it has been studied. Randomized trials in knee replacement show that adductor canal blocks lower pain scores and opioid use in the first day while preserving the thigh strength needed to walk. Trials in shoulder surgery show interscalene blocks reduce early pain substantially. Meta-analyses of abdominal wall blocks for cesarean birth and laparoscopic surgery show consistent, if smaller, reductions in opioid consumption.

Limitations are practical. The numbness wears off, sometimes abruptly overnight, so the oral medicines need to be on board before it does. Rarely, a block causes temporary nerve irritation; permanent injury is very uncommon. Blocks also require a skilled anesthesiologist and time in the pre-operative area.

If your operation involves a limb, the chest wall, the abdominal wall or a joint, asking whether a block is part of the plan is one of the highest-yield questions you can bring to the pre-op appointment.

Where do opioids still fit in a modern pain plan?

Opioids have not disappeared from surgical care, and pretending otherwise does patients a disservice. Medicines such as oxycodone, hydrocodone, morphine and tramadol act on receptors in the brain and spinal cord that dampen the perception of pain. For the sharp, severe pain of the first day or two after a major operation, they remain effective and sometimes necessary.

What has changed is their role. Under multimodal principles, opioids are no longer the foundation; they are the rescue. They are added when scheduled non-opioid medicines and a block are not enough, and they are stopped as soon as the pain curve allows. For many smaller operations, including many hernia repairs, laparoscopic procedures and hand surgeries, randomized and observational studies show patients do well with little or none.

The reasons for restraint are concrete. Opioids slow the gut, and constipation after surgery is both common and miserable. They cause nausea, itching, drowsiness and, at higher exposure, slowed breathing. They disrupt sleep architecture, which paradoxically worsens pain sensitivity. A large US insurance database study found that around 6 in 100 people who had never used opioids before an operation were still filling prescriptions three months later, regardless of whether the surgery was major or minor. That figure comes from observational data, so it cannot prove cause, but it was consistent enough to reshape prescribing norms.

None of this means someone in severe pain should refuse an opioid out of fear. Uncontrolled pain has its own harms: it impairs breathing, delays walking and is itself a risk factor for pain becoming chronic. The goal is the smallest exposure that keeps pain at a level where you can breathe deeply, cough, walk and sleep.

Every question about which opioid, whether to take one at all, and when to stop belongs with the prescribing clinician, who can see the whole picture.

Opioid alternatives without a prescription: ice, movement, breath and sleep

Some of the most reliable tools for pain after surgery come from the bedside rather than the pharmacy. Their effects are modest individually, which is exactly why they belong in a multimodal plan.

Cold therapy reduces swelling by narrowing blood vessels and slows the firing of pain nerves. Randomized trials after knee surgery and cesarean birth show small but real reductions in pain scores and opioid use. Practical points matter: a cloth barrier between skin and ice, sessions of about 15 to 20 minutes, and never applying cold to numb skin, where you cannot feel a burn developing.

Early mobilization sounds counterintuitive when moving hurts, but walking within hours of many operations is now standard. Movement disperses laparoscopic gas, prevents stiffness, lowers clot risk and seems to reduce pain over the following days, probably by interrupting the cycle of guarding and spasm.

Breathing and relaxation techniques lower the body’s stress response. Slow, diaphragmatic breathing and guided imagery have been tested in randomized trials with consistent, small reductions in pain and anxiety. A Cochrane review of music listening around surgery found it reduced pain and anxiety modestly across dozens of trials, with no downside.

Sleep deserves more attention than it gets. Even a single night of poor sleep lowers pain thresholds in healthy volunteers, and hospital nights are rarely restful. Protecting sleep at home, with pain medicines timed before bed and screens put away, pays back during the day.

Transcutaneous electrical nerve stimulation, or TENS, uses mild electrical pulses through skin pads to compete with pain signals. Evidence is mixed and mostly from small trials; some people find it helpful, and it is low risk when used as directed.

These are non-drug opioid alternatives, not replacements for medicine when pain is severe. They work best layered onto a sound pharmacological base.

Suzetrigine and the adjuncts: what the newer options actually offer

Suzetrigine arrived with enormous expectations, so it is worth being exact about what the trials showed. In two phase 3 randomized, placebo-controlled trials, one after abdominoplasty and one after bunion surgery, people taking suzetrigine reported significantly less pain over 48 hours than those taking placebo. In the same trials it was not shown to be superior to the comparison arm of a hydrocodone-acetaminophen combination. In plain terms: it works better than nothing, roughly as well as a standard opioid combination, and without acting on opioid receptors. Common side effects in the trials were itching, muscle spasm and rash. It is approved for moderate-to-severe acute pain in adults; whether it suits a particular patient, and how it fits alongside acetaminophen and NSAIDs, is a decision for the prescribing clinician. Long-term safety data in broad populations do not yet exist because the drug is new.

Gabapentinoids, meaning gabapentin and pregabalin, were widely added to surgical protocols in the 2010s on the theory that they would calm nerve excitability. A 2020 meta-analysis of more than 280 randomized trials concluded they produced no clinically meaningful reduction in pain and increased dizziness and visual disturbance. Many anesthesiology groups have since dropped routine use, although they remain reasonable in selected situations such as pre-existing nerve pain.

Ketamine, given in small amounts during anesthesia, blocks a receptor involved in pain amplification. A Cochrane review found it reduces post-operative opioid consumption and nausea, with hallucination-type effects being the main drawback. It is used mainly for major surgery and for people who take opioids long term.

Intravenous lidocaine infusions and dexamethasone, a steroid, each show modest opioid-sparing effects in randomized trials of abdominal surgery. These are operating-room tools chosen by the anesthesiologist, not take-home medicines.

The pattern across all of them is the same: useful, incremental, and most effective as part of the mix.

Pain after surgery options at a glance

The table below summarizes the main tools, where they act and how confident the evidence is. “Strong” means multiple randomized trials or meta-analyses point the same way; “moderate” means trials exist but are smaller, mixed or limited to certain operations; “limited” means mostly observational data or expert opinion.

Approach	Where it acts	What the evidence shows	Evidence strength	Main cautions
Scheduled acetaminophen plus NSAID	Tissue and spinal cord	Lower pain scores and 20–30% less opioid use versus either alone	Strong	Liver (acetaminophen); kidney, stomach, heart (NSAIDs)
Nerve blocks and regional anesthesia	Peripheral nerve	Marked early pain reduction after limb, chest wall and abdominal surgery	Strong for studied procedures	Wears off; rare temporary nerve irritation
Opioids as rescue	Brain and spinal cord	Effective for severe breakthrough pain; side effects rise with exposure	Strong for efficacy	Constipation, nausea, sedation, dependence with prolonged use
Suzetrigine	Peripheral pain nerves (NaV1.8)	Better than placebo; not superior to an opioid combination in two trials	Moderate (new, two trials)	Itching, rash; limited long-term data
Ketamine (intra-operative)	Spinal cord amplification	Modest reduction in opioid use and nausea	Moderate	Dream-like or dissociative effects
Gabapentinoids	Nerve excitability	No clinically meaningful pain benefit in large meta-analysis	Strong (against routine use)	Dizziness, sedation, visual disturbance
Cold therapy and early walking	Tissue and spasm cycle	Small, consistent pain reductions	Moderate	Skin injury if cold applied to numb areas
Music, breathing, relaxation	Brain perception	Modest reductions in pain and anxiety	Moderate	None of note

Two things stand out. The best-supported elements are the oldest and least glamorous. And the one approach the evidence now argues against, routine gabapentinoids, was a default in many hospitals only a few years ago. Protocols move; so should expectations.

What the evidence actually says, and how strong it is

Grading the evidence matters because not every claim in this field rests on the same footing.

Highest confidence: combining acetaminophen with an NSAID beats either alone, and adding these on a schedule lowers opioid use. This comes from dozens of randomized controlled trials pooled in systematic reviews. Nerve blocks reduce early pain after knee, hip, shoulder and abdominal surgery; again, multiple randomized trials and meta-analyses agree. Routine gabapentinoids do not help meaningfully; a very large meta-analysis of randomized trials settled this.

Moderate confidence: suzetrigine is effective against placebo for moderate-to-severe acute pain after two types of surgery. Two phase 3 randomized trials is a respectable start but a narrow base; its performance across the full range of operations and patients is not yet known. Low-dose ketamine, intravenous lidocaine and dexamethasone each reduce opioid consumption modestly in randomized trials, with effect sizes that are real but small. Cold therapy, music and relaxation techniques show consistent small benefits in trials that are often unblinded, which inflates results somewhat.

Lower confidence, mostly observational: the link between larger opioid prescriptions after surgery and persistent use months later is drawn from insurance and registry data. It is consistent across many studies but cannot fully separate the prescription from the pain that prompted it. The protective effect of ERAS pathways on long-term outcomes is likewise observational; the pathways bundle many changes, so no one can say which component matters most. The idea that NSAIDs impair bone or bowel healing in humans comes from animal studies and retrospective reviews, with randomized evidence sparse and conflicting.

Expert opinion: much day-to-day practice, including which block to choose, how long to continue scheduled medicines, and when to taper, is guided by consensus statements from anesthesiology societies rather than head-to-head trials.

The takeaway is not that weaker evidence should be ignored. It is that the firmest ground lies under multimodal basics, and the newest, most-discussed options sit on a foundation still being built.

Chronic post-surgical pain: is it normal to still hurt months after surgery?

Most people are pain-free, or nearly so, within weeks. A meaningful minority are not. Chronic post-surgical pain is defined as pain that develops after an operation and persists for at least three months beyond the expected healing time, without another explanation such as infection or recurrence of the original disease. It is recognized as its own diagnosis in the World Health Organization’s eleventh International Classification of Diseases, which has helped it be taken more seriously.

How common it is depends heavily on the operation. Observational cohorts report rates from roughly 10% after minor procedures to as high as 30–50% after amputation, thoracotomy, breast surgery and some hernia repairs. Severe, disabling pain is less frequent, affecting an estimated 2–10% overall. These are observational figures and vary with how pain is measured.

Mechanisms differ from acute pain. Nerves cut or stretched during surgery can heal abnormally and fire spontaneously; this produces burning, shooting or electric sensations, numbness alongside pain, and exquisite sensitivity to light touch. Scar tissue can trap small nerve branches. The spinal cord and brain can also become sensitized, so signals that would once have registered as mild are amplified.

Risk factors identified in observational studies include severe acute pain in the first days, pre-existing chronic pain anywhere in the body, anxiety or depression before surgery, younger age, and operations that involve known nerve pathways. This is one reason good acute pain control is considered more than a comfort issue.

Mild tenderness, pulling or numbness around an incision for several months is common and usually settles. Pain that is burning or shooting, that is worsening rather than plateauing, or that limits daily activity three months on is different and warrants evaluation. Treatments studied include nerve-targeted medicines, physical therapy, targeted injections and psychological approaches to pain; which is appropriate is a decision for a clinician, often in a dedicated pain service.

Common myths about pain after surgery and opioid alternatives

Myth: a new non-opioid pill has made opioids obsolete. Suzetrigine is a real advance, but in its pivotal trials it matched, rather than beat, a standard opioid combination. It adds a tool; it does not retire the others. Severe pain after major surgery still sometimes needs an opioid, and that is not a failure.

Myth: taking any opioid after surgery means you will become dependent. Observational data suggest persistent use develops in a small minority, around 6 in 100 opioid-naive patients in one large study. Risk rises with longer courses and larger supplies, which is exactly why plans now aim for short use. A few days of an opioid for severe pain, under supervision, is very different from an open-ended prescription.

Myth: you should wait until pain is bad before taking anything. Pain is easier to prevent than to chase. Scheduled acetaminophen and anti-inflammatories exist precisely so that pain never climbs to the point where only an opioid will do. Toughing it out often leads to more medicine overall, not less.

Myth: over-the-counter medicines are too weak to matter after an operation. The combination of acetaminophen and an NSAID is the best-evidenced element in the whole field, with randomized trials showing it outperforms either alone and reduces opioid needs by a fifth to a third.

Myth: nerve blocks are only for people who refuse general anesthesia. Most blocks are given alongside general anesthesia or sedation, specifically to cover the hours after you wake up.

Myth: pain that lasts months means the surgery went wrong. Chronic post-surgical pain can follow technically perfect operations, because it arises from how nerves heal rather than from surgical error. It deserves assessment, not blame.

Myth: cannabis products are a proven opioid alternative after surgery. Trials of cannabinoids for acute post-operative pain have been small and largely negative or inconclusive. Any question about their use belongs with your surgical team, who also need to know about them because of interactions with anesthesia.

When to see a doctor about pain after surgery

Most pain after surgery follows the predictable curve: worst in the first days, then steadily better. Deviations from that pattern, or pain with certain companions, need a prompt call to the surgical team or, for the most serious signs, emergency care.

Call the surgeon’s office the same day if you notice any of the following:

• Pain that is increasing after day three instead of easing, or that improved and then returned sharply.
• Pain that is not controlled by the plan you were given, so that you cannot take a deep breath, cough, walk a few steps or sleep.
• Spreading redness, warmth, swelling or thick or foul-smelling drainage at the incision, or edges that are pulling apart.
• A temperature above 101°F (38.3°C), or shaking chills.
• New numbness, tingling or weakness in a limb, particularly after a nerve block that should have worn off.
• Inability to pass urine, or no bowel movement for several days with abdominal bloating and vomiting.
• Side effects from medicines: persistent vomiting, severe constipation, a rash or hives, confusion, or feeling unusually drowsy.

Seek emergency care immediately for:

• Chest pain, sudden shortness of breath, or coughing up blood, which can signal a clot in the lung.
• Pain, swelling or warmth in one calf, a possible deep vein clot.
• Very slow or shallow breathing, blue lips, or someone who cannot be roused, especially if opioids have been taken.
• Sudden severe abdominal pain with a rigid belly, or heavy bleeding that soaks dressings.
• Swelling of the face, lips or tongue, or difficulty breathing after a new medicine.

For pain that persists beyond three months, or that is burning, shooting or sensitive to light touch, ask for a referral to a pain specialist. Every decision about starting, changing or stopping a medicine, including over-the-counter ones, should go through the clinician who prescribed your plan. Stopping an opioid abruptly after longer use, or doubling up on products that both contain acetaminophen, are two avoidable problems a quick phone call can prevent.

Frequently asked questions

When does pain peak after surgery?

Pain is usually worst in the first one to three days after an operation and then declines steadily. The peak coincides with local anesthetic or a nerve block wearing off and inflammation reaching its height around day two or three. The exact timing varies by procedure, so ask your surgeon which day their patients typically find hardest and what to expect by the end of the first week.

Is it normal for your whole body to hurt after surgery?

Yes, generalized aching for a few days is common. Lying motionless on a firm table for hours, certain muscle-relaxing anesthetic medicines, the body’s inflammatory response and dehydration all contribute. After laparoscopic surgery, trapped gas can cause shoulder-tip pain. Severe pain in one calf, chest pain, breathlessness or body aches with high fever are not part of normal recovery and need urgent assessment.

What are the main opioid alternatives for pain after surgery?

The best-evidenced alternatives are scheduled acetaminophen plus an anti-inflammatory, nerve blocks placed by an anesthesiologist, and non-drug measures such as cold therapy, early walking, breathing techniques and protected sleep. Newer options include suzetrigine, a non-opioid approved in 2025, and operating-room adjuncts such as low-dose ketamine. Which combination suits you depends on the operation and your medical history, and is decided by your surgical team.

Is it normal to still experience pain in my incision months after surgery?

Mild tenderness, pulling or numbness around a scar for several months is common and usually fades. Pain that is burning, shooting, sensitive to light touch, worsening rather than plateauing, or limiting daily life three months after surgery may be chronic post-surgical pain and should be evaluated. A clinician can rule out infection or other causes and discuss nerve-targeted treatments or referral to a pain service.

What is the pain syndrome that can occur after surgery?

It is called chronic post-surgical pain: pain that begins after an operation and lasts at least three months beyond expected healing, with other causes excluded. It is recognized in the World Health Organization’s ICD-11 classification. It often arises from nerves that heal abnormally and fire spontaneously, and it is most frequent after amputation, chest surgery, breast surgery and some hernia repairs.

Does the new non-opioid pain medicine suzetrigine replace opioids?

Not on current evidence. In two phase 3 randomized trials after abdominoplasty and bunion surgery, suzetrigine relieved pain better than placebo but was not shown to be superior to a hydrocodone-acetaminophen combination. It works on a sodium channel in peripheral pain nerves rather than opioid receptors, so it avoids dependence risk. Whether it is appropriate for a given patient is a decision for the prescribing clinician.

Can I manage pain after surgery with over-the-counter medicines alone?

For many smaller operations, yes, and this is increasingly the plan. Randomized trials show acetaminophen combined with an NSAID controls pain better than either alone and often removes the need for opioids. Larger operations usually need a nerve block and sometimes short opioid rescue as well. Follow the schedule your team provides, and check with them before adding any product, because many contain hidden acetaminophen.

What is a nerve block for surgery pain and does it hurt?

A nerve block is an injection of local anesthetic beside a nerve, guided by ultrasound, that numbs the area the nerve supplies for roughly 8 to 24 hours, or longer with a catheter and pump. Most are placed under light sedation and feel like a brief pinch and pressure. Trials show blocks substantially reduce early pain after joint, shoulder, chest wall and abdominal surgery.

How long is it safe to take opioids after surgery?

Current guidance aims for the shortest course that controls severe pain, typically a few days, with non-opioid medicines continuing as the foundation. Observational studies link longer courses and larger supplies to a higher chance of persistent use months later. The right duration depends on your operation and response, and any decision to continue, reduce or stop belongs with the clinician who prescribed them.

Why do surgeons want me walking the day after surgery if it hurts?

Early movement lowers the risk of blood clots and pneumonia, helps laparoscopic gas disperse, prevents stiffness and interrupts the cycle of muscle guarding that worsens pain over following days. It is a core element of enhanced recovery pathways associated in observational studies with shorter hospital stays and lower opioid use. Pain medicines are timed so that walking is uncomfortable rather than unbearable.

References

• CDC Clinical Practice Guideline for Prescribing Opioids for Pain, United States, 2022
• Cleveland Clinic: Pain Control After Surgery
• MedlinePlus: Pain Relievers
• NHS: NSAIDs

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.