Why some patients need more pain medication during surgery and after

In a 2003 survey cited in an anesthesia lecture deck, 82% of patients experienced acute postoperative pain. Before surgery, the details you share can change how much pain medicine you need during the operation and after it. Medication history, chronic pain, substance use, anxiety, and other personal factors all shape pain response, and the right plan starts before you enter the operating room.

Why pain control varies so much

Pain is not handled the same way by every body. A 2012 review in the pain and genetics literature found that gender, age, race, and anxiety levels all influence how people feel pain and how they respond to analgesics. More recent work has sharpened the picture: younger patients and people who have never taken opioid pain medication are more likely to need few or no opioids after many common surgeries, while chronic opioid use is a recognized risk factor for higher postoperative analgesic needs.

Anxiety matters too, and not just because surgery is stressful. A 2023 PubMed-indexed article found preoperative anxiety is a common experience among adult surgical patients, with incidence varying widely. A 2025 review linked preoperative anxiety to increased anesthesia requirements and stronger hemodynamic responses, meaning your blood pressure and heart rate can rise more easily under stress. A 2023 narrative overview also tied preoperative anxiety to postoperative adverse events.

What to tell your surgeon and anesthesiologist before the operation

The safest way to prepare is to give your team a full, honest medication and symptom history. Cleveland Clinic’s perioperative medication guidance calls an extensive medication history, including nonprescription agents and herbal products, the foundation of effective perioperative medication management. Yale Medicine flags smoking to dietary supplements as factors that can affect the anesthesia plan, and specifically flags marijuana use and cigarette smoking.

Use this checklist before surgery:

• Every prescription medication you take, including medicines for blood pressure, diabetes, depression, sleep, or chronic pain.

• Every over-the-counter drug, including pain relievers, cold medicines, and sleep aids.

• Vitamins, minerals, herbal products, and dietary supplements, since these can interact with anesthesia or change bleeding risk.

• Any smoking, vaping nicotine, or marijuana use, because these can affect how anesthesia is handled.

• Any opioid pain medicine you use now or have used recently, including how often you take it and how long you have been taking it.

• Any chronic pain diagnosis or persistent pain problem, because regular pain often changes what you need after surgery.

• How anxious you feel before procedures, especially if you have had panic, severe fear, or trouble settling before medical care.

They help explain why one patient may wake up needing little more than acetaminophen and another may need a more intensive plan. They also help your team avoid medication interactions and withdrawal problems that can complicate recovery.

How to ask for a pain-management plan

Do not wait until you are in recovery to talk about pain control. Ask for the plan before surgery, when your team can still adjust it to your history and the procedure. If you already live with chronic pain or have used opioids before, say that clearly, because those two facts alone can shift your postoperative needs.

Ask how your team will handle pain in the hospital and after discharge. Washington state’s Bree Collaborative and the Washington Agency Medical Directors’ Group adopted supplemental guidance on postoperative opioid prescribing on July 17, 2018, in response to the growing opioid crisis. That guidance aligned discharge prescribing with best practices: the smallest effective opioid plan, paired with other treatments when appropriate.

You can also ask whether non-opioid options will be part of your recovery. The federal NOPAIN Act took effect on January 1, 2025, to increase patient access to non-opioid treatments for postsurgical pain. If your surgeon offers a medication plan without opioids, or one that uses opioids only as a backup, ask what symptoms should trigger a call and what relief you should expect in the first 24 to 72 hours.

A practical conversation can sound like this:

• “Here is my full medication list, including supplements.”

• “I use nicotine, cannabis, or neither.”

• “I have chronic pain in this part of my body, and this is what I normally take for it.”

• “I have or have not taken opioid pain medication before.”

• “I am very anxious about surgery, and I want that included in the pain plan.”

That kind of disclosure gives the anesthesiologist and surgeon the information they need to choose a safer dose, prepare for more pain if your history suggests it, and avoid assuming that one standard regimen fits everyone.

Why the opioid backdrop still matters

Fear of opioids has made clinicians cautious even when patients still need pain relief after surgery or for chronic pain. Modern guidance is written not as a push to avoid pain medicine altogether, but as a push to match the right treatment to the right patient.