If you asked ten patients that had shoulder surgery - “how painful was shoulder surgery?” you would likely get 10 different answers. The reason for the variation is that there are many different shoulder surgeries, methods for anesthesia and pain control, and individual tolerances to pain. A teenage patient that has never had surgery will respond differently than and adult that has had a previous shoulder surgery. An arthroscopic procedure might be less painful than a total shoulder replacement. Nerve blocks can significantly help with pain for hours to days after surgery. Pain will likely be worse after a surgery performed without a nerve block. Pain control after shoulder surgery should be individualized. It is likely that some form of oral narcotic medicine will be needed postoperatively. The exposure to these medicines should be minimized to reduce side effects (such as nausea, vomiting, constipation) and risk of addiction. Other alternatives to consider are anti-inflammatories such and ibuprofen. Acetaminophen can be used also and is most effective in the first couple days after surgery. Cold therapy in the form of ice, reusable gel packs or a recirculating cold-water pump can be very effective. Appropriate preoperative regional nerve blocks can be very effective at reducing pain after shoulder surgery. They are most effective prior to any painful stimulus therefore I recommend placement before surgery. Effective placement requires using ultrasound guidance and sometimes a nerve stimulator. Shoulder nerve blocks have a low risk of complications if performed by an experienced provider. Rarely they can affect the breathing muscles of the lung on the same side. This will resolve after several hours. Less commonly there can be prolonged (several months) minor symptoms in the blocked nerves such as partial numbness or tingling. You should expect the pain to improve every week after surgery. Pain will likely be worse during and immediately after a physical therapy session. Consider taking oral pain medicine 1 hour prior to therapy and plan on applying cold therapy after the therapy session. Shoulder surgeries are performed hundreds of thousands times a year in the United States. Each surgery requires individual attention to post-operative pain control. Make sure you understand how your surgeon plans to keep your pain after shoulder surgery under control. Written by: William A. Tyndall, M.D., P.H.D. If you have more questions about pain after surgery or would like to schedule an appointment with Dr. Tyndall call 814.942.1166 or visit us online to schedule at www.uoc.com