Recovering from surgery

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Nutrition following surgery

The type of surgery you have will determine what and when you can eat after surgery. Surgeries involving the mouth, throat, abdomen, or digestive tract will likely lead to more restricted diets.

Once you are able to progress beyond clear liquids, an anti-inflammatory, nutrient-dense diet high in vegetables, fruits, whole grains and sources of high quality protein for at least two weeks (but ideally six weeks) after surgery is recommended by experts in integrative oncology, such as Barbara MacDonald, ND, LAc.1MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. (self-published, Amazon, 2016). 

Ask your surgeon or registered dietician about dietary restrictions, such as a diet low in fiber or low in salt, as you begin to eat a variety of foods again.

Pain control after surgery

Pain control not only promotes better quality of life, but can impact your body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more. Pain increases insulin resistance after surgery.2Ljungqvist J. Insulin resistance in surgery. Cirugía y Cirujanos. 2016;84(Supl 1):51-54.

Medications to manage pain

Examples of pain-control options after surgery:

Considerations with opioids

Opioids are an important option in pain management and recovery after surgery. Opioids including morphine, fentanyl, oxycodone, and codeine are often used to manage pain. Use may bring on side effects such as these:3Wiffen PJ, Derry S, Moore RA. Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane Database of Systematic Reviews. 2014 May 29;2014(5):CD011056.

  • Constipation
  • Urinary retention 
  • Sleepiness (somnolence)
  • Nausea
  • Vomiting
  • Loss of appetite (anorexia) 
  • Dry mouth
  • Dizziness
  • Some evidence suggests they may have a negative effect on inflammation and wound healing

Opioids also have the potential to become addictive.

Impacts on immune function

Opioids impair immune function, a body terrain factor connected to cancer.

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of disruption of the immune system from use or sudden withdrawal from opioids; we advise against withdrawing abruptly from opiates and urge you to seek medical supervision for weaning off any opioids.

Impacts on cancer outcomes

Minimizing opioid use may also improve your long-term cancer outcomes.

Preliminary evidence of lower risk of recurrence among men with prostate cancer treated with epidural analgesia compared to opioids in addition to general anesthesia

Opioids: bottom line

In light of both benefits and risks of opioid use, we recommend they be used when necessary but in the smallest amount and for the shortest period possible. We encourage you to consider non-opioid options such as ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) when available. Other non-traditional options for pain control are available.

Managing pain without drugs

In experienced hands, most of these approaches present little risk and may be beneficial.  They may be a good substitute for or addition to conventional pain management options. 

We present complementary therapies supported by evidence for managing pain, especially pain related to surgery. We don’t have a lot of evidence, but this does not mean these approaches will not benefit you. Consider both potential benefits and risks of any pain therapies you use. Full details of the evidence are within each therapy review.

A therapy may show a stronger effect or have more evidence in some situations than in others.

Good or modest evidence of benefit

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means several smaller or at least one large study have found the effect described.

Acupuncture: good evidence

Less pain related to surgery among people with cancer treated with acupuncture (good evidence)

Cannabis or cannabinoids: mixed evidence

Effects not specific to surgery:

  • Less pain from physical damage with oral standardized cannabis extract (modest evidence)
  • InInsufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of an effect on pain among people treated with opioids when adding cannabinoids in combined analyses of studies
Guided imagery: modest evidence

Less pain among people undergoing surgery not specific to cancer and treated with guided imagery, sometimes with music (modest evidence)

Melatonin: modest evidence

Less pain from surgery not specific to cancer among people treated with melatonin (modest evidence)

Reiki: modest evidence

Less surgical pain not specific to cancer among people treated with reiki (modest evidence)

Preliminary or weak evidence of benefit

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

Acupressure: preliminary evidence

Less pain during bone marrow biopsy among people with cancer treated with acupressure (preliminary evidence)

Electrical stimulation therapies: preliminary evidence

Less pain after surgery among people treated with transcutaneous electrical acupoint stimulation (TEAS) (preliminary evidence)

Less pain after lung cancer surgery or coronary artery bypass surgery among people treated with transcutaneous electrical nerve stimulation (TENS) (preliminary evidence)

We are still researching electrical stimulation therapies; these assessments are from our work so far.

Electroacupuncture: preliminary evidence 

Less surgery-related pain among people treated with electroacupuncture (preliminary evidence)

Lower incidence of pneumonia and acute pulmonary injury after resection of pulmonary carcinoma (preliminary evidence)

Combination of therapies: preliminary evidence

Less pain during initial surgery among people with breast cancer using a self-care toolkit of guided mind-body techniques (breathing, progressive muscle relaxation, meditation, guided imagery, and self-hypnosis) and acupressure anti-nausea wristbands (preliminary evidence)

Pain management: impact on body terrain factors

The pain control you choose can impact more than your pain. Some pain control methods promote body terrain imbalances, while others promote balance.

Expert approach: Keith Block, MD

Several imbalances in your body terrain can make your wounds slower to heal, your body more susceptible to infection, and/or your body terrain more favorable to cancer. Balancing these factors in relation to surgery, wound healing, and reducing recurrence risk is especially important:

  • Chronic inflammation
  • Insulin resistance/blood sugar
  • Obesity
  • Imbalanced stress chemistry, including hormones/melatonin
  • Oxidation
  • Compromised immunity, such as from chemotherapy, surgery, anesthesia, or opioid use
  • Impaired blood clotting (coagulopathy)

Integrative physician and CancerChoices advisor Keith Block, MD, recommends an integrative program to address these terrain factors in chapters 14-19 of his book Life over Cancer: The Block Center Program for Integrative Cancer Care.

Immune function

Preserving immune function is important for healing. Some pain management techniques may improve immune function.

Guided imagery › Better markers of immune function among men undergoing surgery for prostate cancer treated with guided imagery (preliminary evidence)

Relaxation techniques › Better markers of immune function among people undergoing breast cancer surgery treated with relaxation techniques (autogenic training) (modest evidence)

Therapeutic Touch® › Better immune function (higher levels of natural killer cells) after vascular surgery among people treated with TT (preliminary evidence)

Opioids, however, are linked to imparied immune function (see above).

Inflammation

Inflammation is a natural and necessary process in healing, but excess or prolonged inflammation can be harmful. Some therapies are linked to lower inflammation.

Astragalus › Less inflammation after mastectomy among people treated with an herbal mixture containing astragalus (preliminary evidence)

Electrical stimulation therapies: Lower markers of inflammation after posterolateral thoracotomy for resectable lung cancer among people treated with transcutaneous electrical nerve stimulation (TENS) (preliminary evidence)

We are still researching electrical stimulation therapies; this assessment is from our work so far.

Oxidation

Maintaining antioxidant levels can lead to lower levels of harmful oxidants.

Acupuncture › Less disruption to antioxidant levels during general anesthesia for radical surgery among people with intestinal cancer treated with acupuncture (preliminary evidence)

Wound healing and infection

Morphine—and perhaps other opioids—may increase your susceptibility to infection.8Wang J, Barke RA, Charboneau R, Roy S. Morphine impairs host innate immune response and increases susceptibility to Streptococcus pneumoniae lung infection. Journal of Immunology. 2005 Jan 1;174(1):426-34; Brack A, Rittner HL, Stein C. Immunosuppressive effects of opioids–clinical relevance. Journal of Neuroimmune Pharmacology. 2011 Dec;6(4):490-502. Alternatives to pain management (above) can reduce this risk.

Some complementary therapies may promote wound healing.

Astragalus: preliminary evidence

Less wound seepage after mastectomy among people treated with an herbal mixture containing astragalus (preliminary evidence)

Relaxation and guided imagery: preliminary evidence

Less surgical wound redness among people participating in relaxation with guided imagery (not specific to cancer) (preliminary evidence)

Regaining mobility and self care

Once surgery is complete, you will likely want to regain your mobility, strength, and daily activities as quickly as possible. Self care and complementary therapies can help.

Self care

Moving More: good evidence

Better strength and quality of life among people with lung cancer participating in exercise after surgery (good evidence)

Complementary care

Complementary therapies can help you return to full mobility and function after surgery.

Good or modest evidence of benefit

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means several smaller or at least one large study have found the effect described.

Acupressure: mixed evidence

Lower incidence of nausea and vomiting after surgery among people treated with acupressure (modest evidence)

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on recovery time, length of hospital stay, or return to normal physical activities among people undergoing major laparoscopic procedures treated with acupressure devices in a preliminary study

Electrical stimulation therapies: good and preliminary evidence

Shorter recovery of gastrointestinal function after surgery among people treated with transcutaneous electrical acupoint stimulation (TEAS) (good evidence)

Higher scores of lung function after posterolateral thoracotomy for resectable lung cancer among people treated with transcutaneous electrical nerve stimulation (TENS) (preliminary evidence)

Quicker return to lung function after coronary artery bypass surgery among people treated with TENS  (preliminary evidence)

We are still researching electrical stimulation therapies; this assessment is from our work so far.

Guided imagery: mixed evidence

Effects not specific to people with cancer:

  • Less pain related to surgery among people treated with guided imagery, sometimes with music (modest evidence)
  • Better quality of sleep scores at the time of surgery among people treated with a guided imagery tape with music and relaxing text (preliminary evidence)
  • Shorter time to first bowel movement after colorectal surgery, but no effect on complications or itching (pruritus) among people treated with guided imagery and music (preliminary evidence)
  • Less surgical wound redness among people participating in relaxation with guided imagery  (preliminary evidence)
  • No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on lung (pulmonary) function after surgery among elderly people treated with guided imagery in a small study
Melatonin: good and preliminary evidence

Effects not specific to people with cancer:

  • Less anxiety after surgery among people treated with melatonin (good evidence)
  • Better sleep quality after surgery among people treated with melatonin (preliminary evidence)
Relaxation techniques: modest evidence

Less fatigue after surgery or stem cell transplant among people with cancer treated with relaxation, sometimes with other complementary therapies (modest evidence)

Better quality of life after surgery among people with cancer treated with relaxation, sometimes with other mind-body therapies (modest evidence)

Preliminary or weak evidence of benefit

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.

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Keep reading about integrative approaches to surgery

Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewer

Whitney You, MD, MPH

Research Consultant
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Research Consultant

Last update: August 25, 2022

Last full literature review: September 2021

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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