Poorly managed postoperative pain is a clinically significant problem that harms physical recovery, psychological well-being, and long-term health outcomes. Despite advances in anesthesia and analgesia, postoperative pain remains undertreated for many patients, often due to inconsistent assessment, inadequate pain control strategies, or fear of medication-related risks. The consequences of this undertreatment extend far beyond short-term discomfort.
From a physiological standpoint, unrelieved pain triggers a stress response characterized by the release of catecholamines and cortisol. This response can increase heart rate, blood pressure, and oxygen consumption, placing additional strain on the cardiovascular system. In vulnerable patients, particularly older adults or those with preexisting heart disease, this stress can contribute to myocardial ischemia or arrhythmias. Poor pain control also interferes with normal respiratory function. Patients who experience significant pain may breathe shallowly or avoid coughing, increasing the risk of atelectasis pneumonia, and other pulmonary complications after surgery.
Pain also directly limits mobility and rehabilitation. Early ambulation and participation in physical therapy are critical components of postoperative recovery, especially after orthopedic or abdominal procedures. When postoperative pain is poorly managed, patients are less likely to move, potentially leading to harms such as muscle deconditioning, joint stiffness, and delayed functional recovery. Immobility further increases the risk of deep vein thrombosis and pressure injuries, prolonging hospital stays and raising the likelihood of readmission.
The psychological harms of poorly managed postoperative pain are equally important. Persistent severe pain can provoke anxiety, fear, and a sense of helplessness, undermining a patient’s confidence in the recovery process and in the healthcare system itself. Sleep disruption is common, and sleep deprivation can worsen pain perception, creating a self-reinforcing cycle. For some individuals, especially those with prior mental health conditions, unmanaged pain may contribute to depressive symptoms or post-traumatic stress related to the surgical experience.
One of the most significant long-term harms associated with inadequate postoperative pain management is the development of chronic postsurgical pain. When acute pain is intense and prolonged, it can lead to changes in the nervous system that persist long after tissue healing should have occurred. Chronic pain following surgery can impair quality of life, limit the ability to work, and increase reliance on healthcare services. In this sense, poor acute pain management is not only a short-term challenge but also a missed opportunity for prevention inadequate pain control can also contribute to problematic opioid use.
Patients whose pain is insufficiently treated may seek higher doses, use medications inconsistently, or turn to non-prescribed sources in an attempt to find relief. Conversely, when pain is managed thoughtfully using multimodal strategies and appropriate monitoring, the need for high-dose opioids often decreases. Thus, poor pain management can undermine efforts to reduce opioid-related harms.
At a systemic level, poorly managed postoperative pain increases healthcare costs through longer hospitalizations, higher complication rates, and increased use of follow-up services. It can also exacerbate health inequities, as patients with communication barriers, cognitive impairment, or implicit bias against them are at greater risk of having their pain underestimated or dismissed.
Postoperative pain is neither a trivial nor inevitable aspect of surgery. When it is poorly managed, it can compromise recovery, mental health, and long-term outcomes while placing additional burdens on patients and healthcare systems alike. Effective pain management is therefore a fundamental component of high-quality surgical care, essential not only for comfort but for safety, healing, and overall well-being.