Pain Management After Minimally Invasive Spine Surgery

The best way to manage a person’s pain is an individualized assessment of the patient to see how they respond to different types of treatment. The best treatment for pain management following a minimally-invasive procedure is multifaceted: activity modification, using a back brace, or taking some traditionally used medications. If those medications do not work, the patient can consider narcotic medication. It is a multifaceted approach based on the individual and what works best for them.

With these minimally invasive procedures, patients typically are not in severe pain after the procedure because the physician goes in and addresses the disorder without irritating a lot of the tissues around. The first two to three days after surgery, patients may experience a level of moderate pain. While, like with any procedure, the post-operative experience varies, it would be unusual to have severe pain after a minimally-invasive spine surgery. How healthy a patient is, and the shape they were in before their procedure can play a role in how they recover post-procedure.

Many times, the degree of post-operative pain is based on pre-operative pathology, so if a person had four massively herniated discs to address, they would likely experience more pain than someone who had a straightforward single disc herniation.

Finding the Best Suited Method of Pain Management

Finding the best method of pain management depends on the type of procedure had. How bad a patient was prior to the procedure may control how they recover. Some people require more medications and activity modifications than others.

Generally, the best way to manage someone’s pain is to individualize their pain management based on different factors, including what their previous condition was, the procedure they had, and what medications they can tolerate. For example, some people cannot take different types of opiate medications. An individualized pain management assessment done by the physician works to discover the best recovery path to take.

If everything goes perfectly, patients may feel better in the recovery room. Over the next seven to 10 days, their symptoms continue to improve with the right recovery plan.

Adverse Opiate Reactions

Some patients who have previously taken opiates experienced complications such as itching, nausea, and vomiting as adverse side effects. These symptoms are not necessarily allergies, however, some people have such bad side effects, it is nearly impossible to take the medication. Pain medications are used on a trial-and-error basis unless the patient has previously had the medication.

Relieving Pain Directly Following the Procedure

Frequent changes in position and wearing a back support or a neck brace can help with pain management. With a lower back procedure, the patient is given a back support to take some of the stress off of their back. 

The physician also prescribes some narcotic pain medication which should only be taken as needed. Sometimes, the patient is given additional anti-inflammatory medications and/or steroids after the procedure. Being compliant with the medication used can also help with pain management.

With more complex procedures, patients may have a bit more prolonged recovery and this can have an impact on their pain level.

Anesthesia

Local anesthesia is not typically given after the surgery. The patient is given a local anesthetic during the surgery which tends to last, and longer-acting local anesthetic can last up to eight hours, so the patient receives some immediate post-operative relief from local anesthetics. However, the doctor does not administer any continuous local anesthetics after the procedure.

Medications

Most of the time, different types of narcotic medications, steroidal medications, and non-steroidal medications are used to manage pain directly after the procedure. Rarely would the physician consider implementing injections or other forms of pain management.

Anti-seizure medications like gabapentin can be used to suppress the reinnervation-type symptoms that patients may feel after a surgery like this. When nerves are trying to heal, symptoms can still be felt in the arms or legs. These medications are very good at covering up the symptoms.

Anti-inflammatory medications like Motrin, and over-the-counter medications like Tylenol are also effective at decreasing pain without taking narcotics.

Degree of Pain

If the patient is in moderate to severe pain after surgery, the physician can change their medications around and use different medications. Different types of medications affect patients differently so, sometimes, it is necessary to change a person’s pain medication in the immediate post-operative period. Patients recover rapidly from these procedures and in general, are off the narcotics within the first seven to ten days.