Surgery of any kind is stressful, especially when it is medically necessary, major or unanticipated. Physical factors like life-threatening illness, pain and possible disfigurement make it even worse. Mental factors surrounding the whole process can challenge or exhaust individual and family coping mechanisms. The following are 10 ways surgery can affect mental health with a few tips to help make it bearable.
1.Situational depression. Having to undergo surgery necessitates the relinquishment of control over the surgery itself and the outcome, as well as over normal responsibilities during hospitalization and recovery. Underlying mental health disorders can be exacerbated by the extreme stress and trauma of surgery. To minimize situational depression:
- Stay informed and know what to expect.
- Provide the health care team with a thorough and accurate mental health history.
- Delegate responsibilities to minimize worry.
2.Body image changes. Body integrity changes and scarring affect body image. Adolescents and young adults are particularly sensitive to body image changes, though everyone is to some degree. To cope with body image changes:
- Reframe the changes from negative to positive.
- Talk with others who have been through similar changes.
- Learn about new scar management techniques, such as silicone gel, steroid injections and topical vitamin E.
3.Separation from supportive others. During illness, hospitalization and recovery from surgery, access to normal support systems can be significantly reduced. Though some friends and family may visit or call, the circumstances and atmosphere are not the same and quite limited compared with everyday life. To minimize feelings of separation:
- Stay in communication with family, friends and co-workers when possible.
- Talk with other patients.
- Journal, write letters, read and enjoy social media.
4.Inability to access usual coping strategies. In addition to being separated from loved ones, hospitalization limits access to the simple coping strategies, such as music, art, sex, yoga, exercise, showers and baths, pets, or whatever is normally used to relax and relieve stress. To continue coping strategies in the hospital:
- Bring comfort items from home whenever possible.
- Ask visitors or ancillary hospital staff for assistance with comfort items, such as putting things within reach, or helping to ambulate or bathe.
5.Limited mobility. Most people undergoing surgery experience limited mobility before, during and after surgery. Limited mobility in one part of the body or in general is frustrating and can directly impact both physical and mental health over time. To cope with limited mobility:
- Remember that immobility is temporary, and most people recover or adapt.
- Take advantage of physical and occupational therapy services.
- Ask for help when needed.
6.Sleep disturbances. Normal sleep-wake schedules and circadian rhythms are altered during anesthesia and surgery. Hospitalizations further disrupt sleep patterns, particularly in the intensive care setting. Pain and anxiety also intensify sleep disturbances, which in turn further contribute to pain and anxiety. The following may help improve the quality and quantity of much-needed rest:
- Try to stay on a normal sleep schedule.
- Wash up before going to sleep, sip caffeine-free herbal teas and avoid stressful stimulation.
- Take sleep medications in the short-term, which may be useful for persistent insomnia.
7.Nutritional disturbances. Changes in eating habits due to hospitalization, medical condition, appetite changes and lack of access to usual food choices create nutritional disturbances. Routine nutritional supplements may be temporarily discontinued during illness and hospitalization. These nutritional disturbances can contribute to alterations in mood and the ability to cope with stress, and can trigger digestive disturbances. To maintain healthy eating habits:
- Have supportive others bring favorite foods in accordance with the prescribed diet.
- Bring supplements from home, but be sure to check with the medical team before taking them.
- Request a dietary or nutritional consultation.
8.Changes in medication regimen. Over 70 percent of Americans take one or more prescription medications. Hospitalization and surgery may necessitate the abrupt discontinuation of or other alterations in medication regimen. Changes in regular medications, such as some that are used to control blood pressure, glucose, or psychiatric conditions, can affect mood and responses to stress. To mitigate withdrawal effects and drug interactions:
- Discuss all medications past and present with the prescribing physician; provide vital information about medications: dosage, frequency, side effects, and time and date of last dose.
9.Pain. Few factors can deplete coping mechanisms like physical pain or the fear of pain. Pain perception is mediated by many individual factors, so everyone perceives pain differently. Sometimes the fear of pain, particularly postoperatively, can be more traumatic than the actual pain experienced. To minimize the impact of pain or the fear of pain:
- Learn about the causes and treatments of pain to improve feelings of control and manageability.
- Find out from medical professionals and other patients about what to expect to prevent distorted expectations of pain.
10.Pain medication. Fortunately, postoperative pain is anticipated and minimized through the use of nerve blocks, epidural catheters or systemic narcotics. Postoperative pain is typically the worst for about three to seven days after surgery, and patients are medicated accordingly. When chronic pain is so severe that long-term narcotic medications are required, depression, anxiety and physical dependence can develop. The prescribing physician and the patient or the patient’s advocate must use care so the patient avoids drug dependence. Here are some tips to remember regarding pain medications:
- Genetic differences exist that determine how different people metabolize pain medication. Ask about pharmacogenetic testing preoperatively to help prevent needless trial and error during postoperative pain management.
- Non-narcotic pain relievers are often adequate, provide better relief sometimes than narcotics and have fewer side effects.
- Unremitting pain may signal a complication or other underlying problem.
Getting through illness, surgery and recovery is one of life’s greatest challenges. Accepting the fact that it is a stressful experience and taking steps to minimize the trauma can speed healing and help prevent mental health problems from developing. The body and the mind both have great healing capacities and the ability to become stronger. With a positive mental attitude in place, the surgical experience can be a new beginning of a healthier and happier life.
Sovereign Health of California offers state-of-the-art treatment for prescription drug addiction and behavioral health disorders. Each treatment program at Sovereign is customized according to the needs of each individual patient. We also use a combination of therapeutic approaches to restore lasting prescription drug addiction. Daniel Headrick, M.D., recently spoke at Sovereign Health about pain management and addiction medicine. To find out more about our programs, please call our 24/7 helpline.
Written by Dana Connolly, Ph.D., Sovereign Health Group staff medical writer