How to make pain go away (or at least, politely leave)

Pain & comfort · 6 min read · deep dive

No honest surgeon or anesthesiologist can promise a procedure you will not feel at all. What we can do is stack layers so that what you feel is manageable, brief and nothing you dread. Here are the layers.

Layer 1: Numb the tissue directly

Tumescent and local anesthesia with epinephrine numb the nerves and narrow blood vessels at the site. In large-volume liposuction series, this approach has been associated with minimal blood loss and very low complication rates when done correctly. See how numbing actually works.

Layer 2: Calm the nervous system

Music, hypnosis, virtual reality and guided breathing consistently lower anxiety, and in some studies pain. A meta-analysis of 81 trials found music reduced anxiety and pain around surgery; a 15-minute hypnosis session reduced pain and nausea ratings in a breast-surgery trial. Anxiety before surgery is also linked to a higher risk of lingering pain. See music and hypnosis.

Layer 3: Use nerve blocks where they help

An S-PECS block reduced pain and medication requests in a randomized breast augmentation trial, while a different block (PECS I) did not beat placebo. Evidence matters. See S-PECS and the plot twist.

Layer 4: Multimodal medicines, before and after

Several non-opioid medicines at modest doses beat one big drug. In outpatient plastic surgery, an ERAS protocol with regional blocks cut prescribed opioids from about 332 to 100 morphine milligram equivalents per patient. See pain control is a team sport.

Layer 5: A physician whose only job is you

An anesthesiologist adjusts sedation and local anesthetic in real time. If you feel something sharp, say so. It is information, not a complaint.

What you may still feel

Pressure, tugging, warmth, vibration, the cold of a skin prep. These are normal and distinct from pain. We will tell you what to expect before each step.

Explore your options at a consultation   Take the Comfort Compass

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References

1. Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993;1085-1098. PMID 8234507
2. Kuhlmann AYR, de Rooij A, Kroese LF, et al. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br J Surg. 2018;773-783. PMID 29665028
3. Montgomery GH, Bovbjerg DH, Schnur JB, et al. A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst. 2007;1304-1312. PMID 17728216
4. Theunissen M, Peters ML, Bruce J, et al. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain. 2012;819-841. PMID 22760489
5. Sforza M, Saghir R, Saghir N, et al. Assessing the efficacy of the S-PECS block in breast augmentation surgery: a randomized, double-blind, controlled trial. Plast Reconstr Surg. 2024;1e-9e. PMID 37010475
6. Desroches J, Roy M, Belliveau M, et al. PECS I block for postoperative analgesia in patients undergoing breast augmentation surgery: a randomized double-blind placebo-controlled study. Braz J Anesthesiol. 2020;333-342. PMID 32792131
7. Straughan DM, Lindsey JT, McCarthy M, et al. Enhanced recovery after surgery protocol with ultrasound-guided regional blocks in outpatient plastic surgery patients leads to decreased opioid prescriptions and consumption. Aesthet Surg J. 2021;NP1105-NP1114. PMID 33730152
8. Schoenbrunner AR, Joshi GP, Janis JE. Multimodal analgesia in the aesthetic plastic surgery: concepts and strategies. Plast Reconstr Surg Glob Open. 2022;e4310. PMID 35572190