The 3 P’s (Pain, Poop, Physical Therapy)
for Post-Op Spinal Fusions
Pain control is a key part of your care after surgery. It can help speed recovery and improve the
results of your surgery. This handout was written to help you learn how pain is managed after
You will also learn:
1. How to set real goals for pain control
2. How to manage pain with medicines and non-drug therapies
3. How to keep your bowels regular
4. How to increase your activity at home
5. What to do for dressing changes
6. How to keep your medicines safe
At American Family Children’s Hospital we care about decreasing your pain. We will work
with you to help control the pain. Research studies and our experience with other children who
have had surgery tell us that the best way to control pain is to combine medicines and other
Pain control tips
ξ Use the pain scale used in the hospital at home to check the level of pain.
ξ Use the scale often to check pain the first two days at home. We expect less pain each
o Check less often as pain decreases.
ξ Don’t let pain get out of control; it is best to treat it early.
ξ Use a number of things together to treat pain.
ξ You may have more pain during physical or occupational therapy sessions.
o Take pain medicine before therapy sessions.
Realistic Goals for Pain Control
It is not realistic to take away all of your pain. Too much medicine can make you very sleepy and
may affect breathing. We will work with you to keep you as safe and as comfortable as possible.
We will talk to you about what to expect and what goals to set for pain control. Your nurses will
always be working with you to find the best way to manage the pain.
People feel pain in many ways. Although it is different with each person, you should expect to
have some pain after surgery. We will ask you to tell us about the pain. The pain scale you used
in the hospital was: ________________________________________ . This pain rating is used
to tell us how well you can move, eat, and sleep.
Good pain control should allow you to get some rest without getting too sleepy, and be able to do
activities like physical therapy. Realistic pain goals after surgery may help measure your
progress as you get better. The nursing staff will help you to set a realistic pain goal and match it
with your activity goals. Goals may include:
ξ Better pain control with activity/walking
ξ Sleeping through the night
ξ Able to sit longer in a chair
ξ Able to walk more distance
At the end of the day, you should think about your progress and decide if the pain goal was
realistic. You may need to change the goal.
Non drug Therapies
Using non-drug therapies with pain medicine may help control pain.
Tense or stiff muscles may increase pain. If you would like to try relaxation exercises and
you have internet access, go to the web site www.uwhealth.org; type “relaxation” in the
If you don’t have access to the internet, lie in your bed with your eyes closed.
o Starting at the toes moving up to the head, tense and relax each body part
o “Think” about your toes; While you are thinking about your toes, curl them into a
ball and hold them tight while counting to three; One, two, three. Now, relax your
toes. Take a deep breath and feel the relaxation in your toes.
o Now think about your legs; Hold them very tight while counting to three; One, two,
three. Now, relax your legs. Take a slow deep breath and feel the relaxation in your
o Keep going and moving up the body all the way to the head.
ξ Guided Imagery
Guided imagery is a way to focus the mind on an idea that lets the body relax.
This supports the body’s natural desire to heal. If you would like to try guided imagery
and have internet access, go to the web site www.uwhealth.org; type “guided imagery”
in the search box for information and resources.
Distraction is a way to take your mind off the pain. It works best if it is something that
you can become absorbed in; such as listening to music, reading a favorite book, drawing
or coloring pictures, playing video games, or watching a favorite movie.
ξ Using Cold and Heat Packs
Cold or heat may help swollen or sore body parts. Check with your health care
provider before putting either of these packs on the incision site.
o Put the cold or heat pack on for up to 20 minutes
o Wait at least 30 minutes between treatments
o Cold pack temperature should be around 59° Fahrenheit (15° Celsius)
o Heat packs should be around 104°-115° Fahrenheit (40°-45° Celsius)
o If you have any pain or numbness when using the cold pack, take it off and talk with
your health care provider.
o Do not use cold or heat packs on open parts of skin, or if you have poor circulation.
Medicines you may be sent home with:
Our goal is to give you the best relief from pain. We combine pain medicines that work in
different ways. Not every child needs to take all the medicines listed below. Please follow
specific directions from your health care provider given at discharge.
ξ Tylenol® (acetaminophen)
Tylenol® can be used by itself. It also works with other pain medicines to decrease pain.
It is common to take it “around the clock” for the first 5-7 days after surgery. It can be
taken this way after discharge too. It is common to take Tylenol® before opioid pain
medicine. If Tylenol® does not give enough relief, an opioid can be taken.
ξ Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
This group includes medicines such as ibuprofen, naproxen, ketorolac and Celebrex®.
They give relief from pain, and decrease inflammation. They can be taken with Tylenol®
and opioids. After surgery, ketorolac is given through an intravenous (IV). Once you no
longer need an IV, it can be given by mouth or changed to ibuprofen. Ibuprofen can be a
scheduled medicine after discharge for a few days. It can also be given as needed.
Oxycodone is an effective pain medicine to use if you do not have relief from Tylenol® or
NSAIDs. Your health care provider may prescribe a dose for you to take in the hospital
and at home. Follow the directions on the prescription. Take the prescribed dose until a
few days after surgery and you are ready for a lower dose. Try a lower dose using the
directions on the prescription to guide you. If your pain increases, go back to taking the
larger dose. Try to decrease the dose again in a day or two. If you are not feeling relief
from pain, contact your healthcare provider. It could mean a change in your condition.
Do not take more medicine than your health care provider has prescribed.
o Opioids and Addiction
An opioid is a medicine that people may become addicted to if not used as
prescribed. Addiction can happen when the opioid is used for reasons other than pain
control, such as sleep, anxiety or because of the way it feels. If you have concerns
about addiction, talk to your health care provider.
ξ Muscle Relaxants/Anticonvulsants
Valium® is used after surgery to relax muscles and lessen anxiety. It is common to
discharge home with this as an “As Needed” medicine. This medicine may make you
sleepy. Take this medicine as needed to calm and relax tight muscle spasms or tension.
Gabapentin is used to treat nerve pain and may be taken up to 3 times a day. Patients will
typically take this medicine as ordered by the doctor.
Getting off pain medicines
If at discharge, you are taking scheduled Tylenol®, ibuprofen, and oxycodone as needed,
medicines should be stopped in this order:
1. First, the oxycodone
2. Next, either Tylenol® or ibuprofen
3. Then the other, either Tylenol® or ibuprofen
Dose in Hospital
Frequency in Hospital
Last dose given
Bowel Management/”Poop Plan”
Opioid medicines can cause severe constipation. Eat a high fiber diet, drink plenty of fluids, get
up and move, and take medicines as prescribed by providers. If you are prescribed medicines that
make stools easier to pass, take them. Examples of high fiber foods are: bran flakes, apples,
pears, barley, broccoli, brussel sprouts, peas, lentils, beans, raspberries, black berries, avocados,
oatmeal, and whole wheat pasta.
Call your provider if you have not had a stool by 2-3 days after discharge. Stop taking stool
softeners or laxatives if diarrhea occurs. If diarrhea continues call your doctor. You may
be prescribed stool softeners such as Colace®. This is given to make stools easy to pass and
prevent hard stools. Laxatives such as Senna, Milk of Magnesia® or MiraLAX®, pull water into
the intestines making stool softer and easier to pass.
Physical therapy can be very helpful to increase your strength and range of motion. At times it
may decrease pain. If you haven’t gotten out of bed since surgery, there may be more pain. Our
nursing staff will give you pain medicine before physical therapy sessions in the hospital. We
would like you to take pain medicine and use non-drug therapies before home or clinic physical
It will be decided before or after surgery if you will need a device to get around. The device will
be given to you before discharge, or will be delivered to your home.
1. Continue to walk more each day
2. Sit in a chair longer each day at home
3. You should try to walk at least a mile each day by the six week appointment with the
4. No B (bending), L (lifting), or T (twisting) until your six week appointment
Care after Surgery
You will get written instructions at discharge that are personalized for you.
ξ You may change dressings every few days for 2 weeks and when dressings become
soiled. Do not pull off the Steri-Strips as they will fall off on their own.
ξ Do not shower for 3 weeks to avoid getting the incision wet.
ξ Do not soak incisions in a tub for at least 4 weeks. This promotes healing and decreases
risk of infection.
Back to school
Pediatric Orthopedics staff suggests you do not go to school while taking opioid medicines. If
you feel well, school work can be done at home. Home teaching requests are approved on a case
by case basis. Providers will write notes for school and gym excuses if needed, and order
Tylenol® or ibuprofen for use during school.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 12/2015 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7859