Jaw Relaxation and Postoperative Pain Management

• Let your lower jaw drop slightly, as though you were starting a small yawn.
• Keep your tongue quiet and resting on the bottom of your mouth.
• Let your lips get soft.
• Breathe slowly, evenly, and rhythmically: inhale, exhale, and rest.
• Allow yourself to stop forming words with your lips and stop thinking in words.

TENS therapy is one physical modality for which there is some support. TENS therapy has been effective in reducing self–reported pain and analgesic use following abdominal surgery (Cooperman, Hall, Mikalacki, Hardy, and Sadar, 1977; Hargreaves and Lander, 1989), orthopedic surgery (Jensen, Conn, Hazeirigg, and Hewett, 1985–, Smith, Hutchins and Hehenberger, 1983), thoracic surgery (Liu, Liao, and Lien, 1985; Rooney, Jain, McCormack, Bains, Martini, and Goldiner, 1986), mixed surgical procedures (Neary, 1981; Solornon, Viemstein, and Long, 1980; VanderArk and McGrath, 1975), and cesarean section (Davies, 1982; Smith, Guralnick, Gelfand, and Jeans, 1986). TENS therapy also has improved physical mobility following thoracic (Liu, Liao, and Lien, 1985; Warfield, Stein, and Frank, 1985) and orthopedic (Jensen, Conn, Hazeirigg, and Hewett, 1985; Smith, Hutchins, and Hehenberger, 1983) surgery. Both TENS therapy and sham TENS therapy (that is, application of electrodes without transmission of electric current) significantly reduced analgesic use and subjective reports of pain (Guideline Report, in press). No significant differences were found between TENS therapy and sham–TENS (Conn, Marshall, Yadav, Daly, and Jaffer, 1986; Hargreaves and Lander, 1989; Taylor, West, Simon, Skelton, and Rowlingson, 1983). Even though these findings suggest a placebo effect underlies the reduction of perceived pain and analgesic use during TENS therapy, beneficial effects do, in fact, result (Guideline Report, in press). The physical modalities of acupuncture and electroacupuncture also have been clinically evaluated in postoperative patients, with conflicting findings; no clear analgesic effect has been demonstrated (Evron, Schenker, Oishwang, Granat, and Magora, 1981; Facco, Manani, Angel, Vincenti, Tambuscio, Ceccherelli, Troletti, Ambrosio, and Giron, 198 1; Hansson and Ekblom, 1986; Wigram, Lewith, Machin, and Church, 1986).

How each patient's postoperative pain management program is designed and implemented will vary according to the type of medical facility and services available to support a pain management program. At the least, clinicians should be introduced to these methods so they recognize the benefits of cognitive–behavioral and physical interventions, know the indications for their use, and are able to provide information and counseling to patients. In addition, patients should have access to written information about available therapies, why and when to use
them, and sources for self–management materials or professional consultations.

Catastrophic postoperative events are rarely, if ever, masked by any of the approaches to postoperative pain control previously described. Any sudden or unexplained change in pain intensity requires immediate evaluation by the surgeon. Likewise, a sudden increase in anxiety may signal cardiac or pulmonary decompensation and requires prompt medical or surgical assessment.