Management of Post-Operative Pain

Medication Adjustment

The American College of Emergency Physicians recommends discontinuing cyclobenzaprine as high-quality evidence demonstrates it provides no additional benefit when combined with NSAIDs for acute low back pain 1, 2
A randomized trial showed naproxen plus cyclobenzaprine produced identical functional improvement compared to naproxen plus placebo, with no statistically significant difference (P=0.77) 1, 2
The American College of Emergency Physicians suggests adding scheduled NSAID therapy, such as naproxen 500 mg twice daily, as NSAIDs are first-line pharmacologic treatment for acute musculoskeletal pain 3, 4, 5
The Centers for Disease Control and Prevention recommends screening for contraindications, including cardiovascular disease, chronic renal failure, or previous gastrointestinal bleeding, before prescribing NSAIDs 4

The American College of Emergency Physicians recommends scheduled oxycodone 10-15 mg every 4-6 hours and scheduled naproxen 500 mg twice daily for around-the-clock coverage 1, 2, 3, 4, 5
The American Academy of Internal Medicine suggests adding acetaminophen 1000 mg every 6 hours for additional analgesia 3, 5

The American Society of Anesthesiologists recommends early mobilization as tolerated per orthopedic protocol and physical therapy consultation for positioning and gentle range of motion 6

The American College of Emergency Physicians recommends urgent evaluation for progressive neurologic deficits, such as foot drop, numbness, or weakness 3, 7
The Centers for Disease Control and Prevention suggests urgent evaluation for inability to void or loss of bowel/bladder control 3

The American College of Emergency Physicians recommends reassessing pain scores and functional status within 2-4 hours of medication adjustment and considering consultation with acute pain service for regional anesthesia techniques if pain remains uncontrolled 6
The Centers for Disease Control and Prevention suggests planning for opioid taper beginning 48-72 hours post-operatively and transitioning to non-opioid regimen by post-operative day 5-7 if pain trajectory is appropriate 4, 8