Is HIPEC Surgery Painful?

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. While any surgery carries with it an inherent risk of pain, the medical team takes proactive steps to manage and mitigate this.

Pain management is of paramount importance in HIPEC surgery for several reasons.

Firstly, effective pain control contributes to early mobilisation, which is linked to reduced post-surgery complications such as blood clots or pneumonia. Secondly, good pain control can help expedite the recovery process, allowing the patient to resume normal activities more quickly.

Finally, appropriate management of pain can prevent the development of chronic post-surgical pain, enhancing the overall quality of life for the patient post-procedure.

Options for pain management during HIPEC surgery

There are two main options for pain management during HIPEC surgery, which are typically decided based on individual patient needs and circumstances.

• Regional Anesthesia: This type of anesthesia involves numbing a specific region of the body, in this case, the abdomen. It’s often used in conjunction with a sedative to help the patient relax during the surgery. The advantage is that the patient remains awake, but feels no pain in the anesthetized area.However, since HIPEC surgery needs large incisions and the surgery usually runs for longer duration, we use regional anesthesia only when general anesthesia is contraindicated – e.g. severe lung disease.

• General Anesthesia: This is a more comprehensive form of anesthesia where the patient is put into a state of controlled unconsciousness for the duration of the surgery. This means the patient will not be aware of the procedure and will not feel pain.

The choice between regional and general anesthesia will depend on various factors including the anticipated complexity of the surgery, patient health status and patient preference.

What to expect after HIPEC surgery in terms of pain ?

After HIPEC surgery, patients may experience some degree of pain and discomfort. This is normal and expected as the body undergoes a major surgical procedure. However, with appropriate pain management techniques in place, this discomfort can be minimized and controlled.

The level of pain experienced will vary from person to person and depends on individual factors such as pain tolerance, type of anesthesia used, length of surgery and the extent of the disease. It’s important for patients to communicate their pain levels to their medical team throughout the recovery process so that adjustments can be made to their pain management plan as needed.

Short-term pain management

Short-term pain management post HIPEC surgery primarily involves the administration of pain-relieving medications. These can include a range of drugs from non-opioid analgesics such as Paracetamol and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) to opioids like Morphine or Fentanyl, depending upon the intensity of the pain.

Epidural analgesia may also be used for a few days after the surgery. Non-drug methods, like physiotherapy and relaxation techniques, can be employed alongside medication to aid pain relief.

It’s crucial to note that these techniques should be individualised, and the should be closely monitored for potential side effects of medications and adjust dosages as necessary. This stage of pain management is typically for the initial days following surgery, while the patient is still in hospital.

Long-term pain management

For long-term pain management after HIPEC surgery, the focus shifts towards facilitating recovery at home and managing any chronic pain symptoms. Analgesic medications may still play a role, but the use of potent opioids is typically reduced or phased out to avoid dependency. Non-opioid analgesics, such as Paracetamol or NSAIDs, might be continued, and in some cases, medications specifically for neuropathic pain might be introduced.

In addition to this, a variety of non-pharmacological interventions may be utilised. Physical therapy and gentle exercise can help to improve overall physical condition and reduce discomfort. Cognitive-Behavioural Therapy (CBT) and other psychological interventions may also be beneficial in managing the emotional aspects of chronic pain.

Lifestyle adjustments, such as maintaining a healthy diet, ensuring sufficient sleep, and avoiding tobacco and excessive alcohol, can also make a significant difference in managing long-term pain.

Patients should to keep regular follow-ups with their HIPEC surgeon to monitor progress and make necessary adjustments to the pain management plan. Remember, access to pain management is a fundamental human right and every patient has the right to have their pain controlled effectively.

Read more: Life expectancy after HIPEC surgery

Factors that influence pain levels after HIPEC

Several factors contribute to the pain levels experienced by patients after HIPEC surgery.

1. Type of Cancer: The type of cancer a patient has can significantly impact the level of pain experienced post-operatively. Certain cancers may result in more invasive surgery or larger surgical incisions, leading to higher pain levels. Furthermore, some cancers might inherently cause more discomfort due to their nature or location in the body.
   

2.Extent of Surgery: The extent of the surgery performed directly influences the severity and duration of post-operative pain. Larger, more invasive surgeries typically result in more significant post-operative pain than smaller, less invasive procedures. This is due to the increased tissue disruption and longer healing times associated with more extensive surgeries.

3. Individual Pain Tolerance: Pain is a highly subjective experience, and individual pain tolerance varies widely. Some patients may naturally have a higher tolerance for pain, while others may find the same level of pain intolerable. Psychological factors, previous experiences with pain, and genetic factors can all influence individual pain tolerance.

4.Pre-existing Conditions: Patients with pre-existing chronic pain conditions or other medical conditions may experience higher levels of pain after HIPEC surgery. These conditions can make it more challenging to manage post-operative pain effectively and may require additional interventions.

5.Patient Compliance: The compliance of the patient with their pain management plan also plays a crucial role in managing post-operative pain. Patients who are actively involved in their pain management and follow the prescribed treatment plan are more likely to experience better pain control and recover quicker

6.Multimodal Pain Management: A multimodal approach to pain management is often the most effective in managing post-operative pain after HIPEC surgery. This approach combines different types of pain relief medications, including opioids, non-opioids, and adjuvant therapies like nerve blocks or epidural analgesia.

7.Patient Education:

Educating patients about their pain management plan, potential side effects of medication and coping strategies can also help in managing post-operative pain effectively. This includes teaching patients how to use relaxation techniques, distraction methods and other non-pharmacological interventions to reduce pain and improve their recovery.

8.Rehabilitation: Rehabilitation plays an essential role in managing post-operative pain and improving overall recovery after HIPEC surgery. Physical therapy and occupational therapy can help patients regain strength, mobility and function, which can also contribute to pain reduction.

9.Emotional Support: It is common for patients to experience emotional distress and anxiety after undergoing HIPEC surgery. Emotional support from loved ones, as well as mental health professionals, can help in managing post-operative pain by reducing stress levels and promoting a positive outlook during the recovery process.

 10.Nutrition: Proper nutrition is vital for the body to heal and recover after surgery. A balanced diet rich in protein, vitamins and minerals can help promote tissue healing and reduce inflammation, which can also contribute to pain reduction.

 11.Follow-Up Care: Following HIPEC surgery, patients should attend all scheduled follow-up appointments. This allows the team to monitor their recovery progress and make any necessary adjustments to pain management strategies.

12.Pain Diary: Keeping a record of pain levels, triggers and pain management techniques can help patients and their pain physicians identify patterns and make informed decisions about their pain management plan.

13.Managing Expectations: While HIPEC surgery can provide long-term benefits, patients need to understand that the recovery process can be challenging and may involve some pain. Managing expectations and having realistic goals can help in coping with post-operative pain.

14.Alternative Therapies: Some patients may find relief from post-operative pain through alternative therapies such as acupuncture, massage or meditation. It is important to discuss these options with a HIPEC surgeon before incorporating them into the pain management plan.

15.Stay Active: While rest is important for recovery, remaining physically active in moderation can also help with pain management. Low-impact exercises such as walking or gentle stretching can improve circulation, reduce stiffness and promote healing.

16.Using Cold/Heat Therapy: Both cold and heat therapies can play a significant role in pain management. Cold therapy can help reduce inflammation and numb the affected area, while heat therapy can aid in loosening stiff joints and relieving muscle discomfort.

17.Getting Enough Rest: Adequate rest is key in the healing process. It allows the body to repair and regenerate, thereby reducing pain and discomfort.

18.Following Doctor’s Instructions: Always adhere to the medical advice and instructions provided. This includes following the recommended exercise regimens, dietary plans, wound care instructions and medication schedules. These guidelines are designed to facilitate optimal recovery and mitigate post-operative pain.

Managing post-operative pain following HIPEC surgery is crucial for successful recovery. The key is to employ a combination of strategies including regular follow-ups, pain diaries, expectation management, alternative therapies, proper medication, and moderate activity.

Each patient’s experience will be unique, and they need to work closely with their specialists to tailor a pain management plan fitting to their needs. Ensuring effective communication and adherence to the recommended practices can significantly enhance the recovery process and overall quality of life post-surgery.

Read more-Cost of HIPEC Treatment in Mumbai

When to contact your care team about pain?

It is crucial to reach out to your pain physician at the earliest sign of unmanageable pain. This could be when your pain level consistently stays high despite medication, if the pain suddenly increases, or if you experience new pain. Swift communication can aid in necessary adjustments to your pain management plan, ensuring your comfort and recovery.

Signs Your Pain is Uncontrolled

Uncontrolled pain can manifest in various ways. It could involve a sudden increase in the intensity of the pain, continuous discomfort despite taking pain medication, or a change in the nature of the pain. Other indicators might include difficulty sleeping due to pain, increased anxiety and distress, or a decline in your capacity to perform daily activities.

Questions to Ask Your Doctor

Formulating a list of questions for your specialist can be helpful in understanding and managing your post-operative pain. Some potential questions could include:

1. How long should I expect this level of pain?
2. Are there other pain relief options I could try?
3. What are the side effects of my current medication?
4. What should I do if my pain suddenly worsens?
5. Is there a pain management specialist I can consult?
6. Should I be concerned about dependency on pain medications?

These inquiries will help you better understand your situation and explore additional pain management strategies.

Reach Out for Help

Remember, you don’t have to endure severe post-operative pain alone. Our dedicated care team is here to provide answers and support throughout your journey to recovery. Should you have any further questions or concerns, or if you need advice about your pain management strategy, please feel welcome to contact us.

We’re here to help you get back on your feet, with as little discomfort as possible. Your health and comfort are our primary concerns, so please don’t hesitate to reach out to us. Thank you.