Recovery from any surgery may cause pain. For many people, pain is one of their most significant concerns when considering surgery. However, pain after bariatric surgery can be normal and is expected. Pain can be a sign that your body is healing. On the contrary, it can also be a sign that something is not well within your body. Read on to learn about what to expect when it comes to pain after bariatric surgery.

How does pain serve the body?

We tend to associate pain with negativity. Indeed, our perception of pain is just one of the many adaptive mechanisms that our brain uses to keep our bodies safe. Since birth, and even in utero, our nervous system responds to harmful stimuli by sending signals to our minds so that our bodies can be told how to react.

Nociceptors are special pain receptors located throughout our bodies. These specialized receptors respond to bodily damage by transmitting signals to the spinal cord and the brain. Nociceptors are capable of differentiating pain location, intensity, and severity. Furthermore, nociceptors are classified based on the different types of stimuli they respond to, including:

• Thermal (extreme hot or cold temperatures)
• Mechanical (tearing, stretching, or pulling of muscles, tendons, and ligaments)
• Thermo-mechanical (respond to both temperature and mechanical threats)
• Chemical (respond to chemical signals released by your body that indicate tissue damage, such as prostaglandins)
• Silent (these receptors are usually “woken up” by tissue inflammation and are found on your organs in your body)
• Polymodal (respond to mechanical, thermal, and chemical stimuli)

While pain is intended to serve you by protecting you from harm, it can also deliver inaccurate information to the brain in some situations. For example, certain medical conditions can lead to hypersensitivity and misfiring of nociceptors, including hyperalgesia, allodynia, and possibly fibromyalgia. When you are recovering from bariatric surgery, it is normal to experience pain in recovery as your body is responding to the incisions and modifications of your digestive tract.

What to expect regarding pain after bariatric surgery

Everyone experiences pain differently. And the amount of pain you can expect to experience is dependent on the type of bariatric surgery. More extensive bariatric surgeries, such as a duodenal switch, gastric bypass, and a gastric sleeve, can be associated with more pain in the post-op period compared to patients who have gastric lap band surgery. Your experience will be highly individualized, and it can be hard to predict how you will react to your surgery.

When you wake up from surgery, you are not likely to experience pain right away as the numbing medications that put you to sleep are still in your system. Bariatric surgery pain usually starts when you begin to move around in bed, or when you get up for the first time. Although it can be uncomfortable to move, movement is key to a quick and strong recovery after surgery. Your doctor will advise you on when and how often you should move immediately after your procedure.

Different locations of pain after bariatric surgery

Along with pain and discomfort around your incision sites, you may experience bariatric surgery pain in the following locations:

• Abdominal pain after bariatric surgery - Generalized abdominal pain can be expected after surgery. While most bariatric surgeries can be performed laparoscopically, the changes made to your digestive tract may be sore. Furthermore, many people experience gas pain after bariatric surgery. One technique for creating more visual space in the abdomen during surgery is to inflate it with carbon dioxide (CO2). Although it helps the surgeon see your organs better, it can leave you feeling painfully bloated after surgery. Walking and using your incentive spirometer can help eliminate your gas pains.
• Stomach pain after bariatric surgery - All bariatric surgeries modify your stomach in some way. Whether it is a gastric sleeve, gastric bypass, duodenal switch, or lap band, the stomach is the main organ that is modified to help achieve your weight loss goals. Therefore, it is expected that your stomach will feel tender after surgery. You may find the discomfort increases temporarily when you begin to take oral liquids because the stomach organ is stretched.
• Shoulder pain after bariatric surgery - It is not uncommon to experience shoulder pain after surgery. Many people experience gas pains that refer to one or both shoulders. Also, shoulder pain may be due to how you were lying on the operating table during surgery. Furthermore, if a person has an anastomotic (surgical) leak in the abdomen, it can refer to their shoulders. This is a concerning complication that should be addressed immediately.
• Chest pain after bariatric surgery - People commonly wake up with chest pain after bariatric surgery because of the way organs are moved in surgery. Indeed, the surgeon may also have repaired a hiatal hernia, which can also contribute to chest pain. This form of pain is considered normal and benign. However, if sudden, severe chest pain develops, it can be a sign of a heart attack. This severe complication from surgery is more likely in people with existing cardiovascular disease, including uncontrolled high blood pressure. If you feel a sudden onset of chest pain after surgery, notify your health care team immediately.
• Back pain after bariatric surgery - Firstly, it is not uncommon to experience back pain after any surgery. Certainly, the way you lay on the surgical table can cause back discomfort. Furthermore, it is normal to feel tension before and after surgery due to emotions and anxiety that may contribute to back pain.
• Joint pain after bariatric surgery - Joint pain is common in overweight and obese individuals. Many people report that their joint pain gets better after surgery because there is less stress on their joints. However, some people report their joint pain worsens, which can be due to hypermobility (or instability) in their joints. Remember, the surgery itself, as well as recovery in the hospital, may lead to joint discomfort immediately after surgery because of stiffness and the natural tendency to guard your incision sites.

How is pain treated after bariatric surgery?

Although pain after bariatric surgery is normal and expected, it is important to manage your pain so that you are comfortable and able to move. Indeed, when you are in the hospital, your nurse will encourage you to cough and deep breathe. You will be encouraged to use an incentive spirometer to reduce your risk of pneumonia after surgery.

For your comfort, your doctor will prescribe pain medication that your nurse will give you based on the level of pain you are experiencing. In fact, in the early phase after surgery, it is important to stay ahead of the pain so you can focus on your exercises and rest. Your nurse may give you intravenous or oral liquid pain medicine after bariatric surgery, as pills may be too harmful to your digestive tract following the procedure. Similarly, you may go home with liquid pain medicine after bariatric surgery to manage your pain once you are discharged from the hospital.

When you should be concerned about your pain after bariatric surgery

The risk of complications in the immediate post-op period after bariatric surgery is relatively low. Most of them are minor complications, but some are life-threatening. Remember, pain is your body trying to tell your brain that something is not right. Certainly, it is expected to feel pain after surgical procedures, but severe pain after bariatric surgery can be cause for concern. Here are some red flags to be wary of:

• Leaks - An early sign of leakage can be an unexplained rapid heart rate of around 120 beats per minute or greater. If a person has an anastomotic leak, it is likely to occur within the first 24-48 hours when you are in the hospital, but it can also occur 5-10 days after surgery. Your body may refer to pain from leakage to one or both shoulders.
• Blood clots - Anyone who undergoes surgery is at risk for blood clots in the legs or their lungs. However, obese patients are at a greater risk. Blood clots can be life-threatening. You will be on preventative medication after surgery to help reduce your risk for blood clots while you are in the hospital.
• Chest pain - While it is normal to wake up with chest pain in recovery from surgery, a sudden onset of chest pain, or feeling like an elephant is sitting on your chest is not normal and is a major red flag. Although the risk is low, bariatric surgery patients are at risk for heart attack and pulmonary embolism.

As you now know, pain after bariatric surgery is a normal part of recovery. However, the level of pain you can expect is dependent on the type of surgery you have and how proactive you are at managing your pain with medication and movement. Some pain is unavoidable, and severe pain can be a sign that you are experiencing a more severe complication from surgery. Most people return to normal activities 3-5 weeks following surgery.

As always, listen to your body. You know you best.