Control Your Pain After Back Surgery With These Tips

Here are a few factors that influence pain after back surgery, and some tips for ensuring a successful back surgery recovery.

Peer Reviewed

Whether you’re having a minor procedure or undergoing major repairs, it’s normal to have pain following spine surgery. Your muscles, ligaments, and bones are being pretty roughed up, after all.

Doctor helping man with back surgery recovery and controlling pain after back surgeryUp to two-thirds of people who have back surgery report poor pain control.

But when that pain isn’t controlled well, it can lead to big problems. In the short term, you could face a lengthier, unhappier hospital stay. In the long term, it could mean delayed recovery, dependence on opioids, and even additional health problems, like chronic pain disorders or blood clots.

Poor pain management after back surgery is distressingly common, reported by up to two-thirds of patients. Fortunately, some key factors—from patient age to type of surgery—can help doctors predict who may end up hurting more and possibly stop excessive post-surgical pain before it starts.

That’s what researchers from the University of Calgary did for one Journal of Neurosurgery study, published online in September 2020. First, they found seven key factors related to poor postoperative pain control. Then, they developed a scale for identifying people likely to experience it, called the Calgary Postoperative Pain After Spine Surgery (CAPPS) score. Finally, they used the CAPPS score to successfully pinpoint patients who were at low, high, and extreme risk.

Factors Contributing to More Pain After Back Surgery

The Calgary researchers started from an original list of 25 factors that might predict insufficient pain management. From that group, they narrowed it down to the final seven:

  • Younger age
  • Being female
  • Daily opioid use prior to surgery
  • A higher degree of back or neck pain before the operation
  • A higher score on the Patient Health Questionnaire-9, a scale commonly used by providers to evaluate depression
  • Surgery involving three or more motion segments, which include vertebrae and discs
  • Having fusion surgery

Of these factors, opioid use was the strongest predictor of poor postoperative pain control. It may not have been a surprise—previous research has suggested it can complicate pain relief.

“If you have been on opioid medications for a long period of time, your perception of pain is fundamentally altered,” explains Rahul Shah, MD, FAAOS, an orthopedic spine surgeon at Premier Orthopedic Associates in Vineland, NJ, who was not involved in the study. “You might not feel some really significant pain that other people will feel, and other, lighter pains that some people may be able to work past, you may feel much more intensely.”

Factors That Did Not Contribute to Pain After Back Surgery

While some factors helped predict pain intensity, others didn’t make much of a difference—at least in this study. These included:

  • Body mass index
  • Surgical approach, meaning whether the surgery was performed through the front, back, or both the front and back of the body
  • Having minimally invasive surgery
  • Having revision surgery, a procedure to correct a previous surgery

Of course, testing every factor linked to pain is impossible, and the study didn’t include things like anxiety, catastrophizing (expecting the worst), and kinesiophobia (fearing movement because it may cause pain). The researchers also conceded that pain itself is subjective, and differs widely from person to person.

Tips for Minimizing Surgical Pain: Before Spine Surgery

Gauging your pain potential can help doctors manage it after spine surgery. But you can help yourself along, too—even before ever seeing the inside of an operating room. Here’s how.

Be prepared. Not knowing enough about your procedure is linked to more pain afterward. Learning what to expect, on the other hand, better prepares you for the aftermath. Expect a full rundown from your surgeon, and don’t be afraid to ask questions. Be sure to discuss the medications you might receive before and after surgery—including side effects and the potential for addiction—as well as non-medication recovery options.

Bring your cardiovascular health up to speed. “The reason is, when you’re able to do that, you can handle the anesthesia, and you can handle what the heart has to go through,” says Dr. Shah. Being in shape may help you move around afterward, too, which can help minimize pain. If you’re able, Shah suggests working your way up to walking for 25 to 30 minutes at a time, raising your heart rate 80 or 90 percent.

Get a handle on opioid use. As the Calgary researchers found, using opioids regularly can affect postoperative pain. “Try and be off of all the narcotic pain medication beforehand. It’s hard to do, but that would be the goal,” says Dr. Shah. Speak with your general practitioner (GP) about a specialist or reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357.

Consider seeing a mental health professional. Depression and pre-surgery pain—two of the seven key factors in the Journal of Neurosurgery study—often feed into each other. “Back problems can make you depressed. You can’t do anything. And so you’re always in pain,” explains Dr. Shah. Fortunately, both may be improved with therapy. Ask your surgeon or GP about getting help; they may be able to provide a referral to a psychiatrist, psychologist or counselor with relevant experience.

Reach out to friends and family. No matter how healthy or prepared you are, back surgery pain and recovery can put you out of commission for a while. So, plan ahead. Say yes to offers to do chores and run errands. Even if you have a hard time leaning on loved ones, now’s the time.

Tips for Minimizing Surgical Pain: After Spine Surgery

Once you leave the hospital, in the days and weeks following spine surgery, you may be able to speed your recovery and lessen your pain by following these general guidelines for spine surgery recovery.

Stick to medication directions. Patients are typically given one or more medications to help manage their pain at home. Among other drugs, these may include opioids, acetaminophen (Tylenol), and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin (Tylenol).

Pay attention to dosage and timing directions, and make sure you get prescriptions refilled on time. Reach out to your provider right away if you have any side effects, or if your pain gets worse.

Move carefully. Your mobility will be limited in the weeks after coming home, whatever the procedure. During this time, it’s crucial you don’t twist your body, bend at the waist, or lift heavy objects (more than 5 or 10 lbs.). Doing so can further damage your back and increase your pain, lots.

Your ability to sit, sleep, drive, bathe, and even have sex will change for a time. To speed recovery, make sure to follow all of your surgeon’s instructions regarding movements. These tips may help, as well:

  • Squat to lift light objects instead of bending over.
  • Maintain good posture when you’re sitting and standing, keeping your hips and shoulders aligned; avoid slouching.
  • Use aids—walking with a cane, using a reacher, and wearing a back support (if recommended by your doctor) can assist movement. Pillows, wedges, or rolled blankets can help support your knees and shoulders as you sleep.
  • Avoid sitting, lying down, or remaining in one position for too long, all of which promote stiffness.

Resume simple activity. “Some people’s initial reaction is to do nothing so that they don’t make pain worse,” says Dr. Shah. But lounging around leads to stiffness and soreness. Instead, ask your provider about activities that are safe for you. Odds are they’ll recommend walking, which can increase stamina and strength while relieving pain and easing stiffness. Experts often suggest starting off with short, periodic walks and working your way up to longer strolls a few times daily.

To know: Wait on your doctor’s go-ahead before beginning a more demanding activity like running or swimming—especially if it involves twisting or lifting heavier objects.

Consider complementary medicine. Some people find alternative approaches to be helpful after they’ve had back surgery. These can be as simple as a massage or more involved, such as transcutaneous electrical nerve stimulation (TENS). During TENS sessions, little electrical pulses are applied to painful areas to ease discomfort.

Additional approaches include acupuncture and psychological treatments like relaxation techniques, guided imagery and medical hypnosis. Many people find these help mentally as well as physically.

Go to PT if prescribed. Many, many people benefit from physical therapy. It can help you regain strength and mobility, not to mention navigate your day-to-day activities—getting dressed, lifting laundry, getting up from a chair, etc.—with less pain.

When to Call a Doctor

Of course, some kinds of pain after spine surgery aren’t normal. They could mean something is wrong, like an infection. Call your provider as soon as you can if you experience any of the following:

  • Drainage or increased pain, bruising, swelling or warmth by your surgical incision
  • Your incision starts to split open
  • Fever of 101°F or over
  • Numbness, weakness, tingling or pain in your arms, hands, fingers, legs or feet
  • Breathing problems or chest pain
  • Problems urinating or having a bowel movement
  • Pain that doesn’t improve over time

The Bottom Line on Back Surgery Recovery

Whatever level of pain you feel after spine surgery, Dr. Shah says one thing is most important to keep in mind: “It will get better.”

“The way that you can convince yourself to understand is, think about the pain that you have before surgery,” he continues. “After surgery, is it the same pain? If it’s not—and typically it’s not—you know it will get better.” Ultimately, understanding that may be the best pain solution, period.

Updated on: 03/02/21
Continue Reading
Is Opioid-Free Spine Surgery the Way of the Future?
Rahul Shah, MD
Continue Reading:

Is Opioid-Free Spine Surgery the Way of the Future?

Is opioid-free spine surgery viable? These experts say yes. Read about their work and why they believe opioid-free spine surgery to be the future.
Read More