After surgery, patients are often asked a familiar question: “How bad is your pain on a scale from zero to ten?” Naturally, most people want that number to be zero. As doctors, we want our patients to be comfortable too. But after many operations, completely removing every trace of pain may not be realistic. And sometimes, trying too hard to reach zero can create problems of its own.

A better question can be: Can you breathe deeply? Can you cough? Can you sleep? Can you get out of bed and start moving?

Pain after surgery should never simply be ignored. If pain is poorly controlled, patients may struggle to move, sleep, breathe deeply, or take part in physiotherapy. But pain treatment is also about balance.

Opioids can be very helpful after surgery, especially when pain is severe. But higher doses can also cause nausea, vomiting, constipation, drowsiness, and, in some patients, slow breathing. The answer is not to avoid opioids. It is to use them carefully and only as much as the patient needs.

For years, postoperative pain guidance developed with input from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists has supported using several approaches together and tailoring treatment to the patient and the operation. In practice, that may mean combining acetaminophen, anti-inflammatory medicines when suitable, local anesthetic techniques, nerve blocks, and opioids when needed. More recently, the American Society of Anesthesiologists’ 2026 guideline on perioperative pain management reinforced the role of local and regional anesthesia techniques in reducing postoperative pain and, in appropriate settings, opioid requirements.

The goal is not to win a contest against the pain score. The goal is to help the patient recover.

Imagine two patients who both say their pain is 4 out of 10. One is sitting up, taking deep breaths, eating, walking to the bathroom, and starting physiotherapy. The other is lying completely still because moving hurts too much. The number is the same. Their recovery is not.

That is why pain scores are useful, but they should not be the only thing we look at. Modern Enhanced Recovery After Surgery recommendations also place pain management within a much bigger recovery plan: helping patients regain normal function while avoiding unnecessary treatment-related problems.

Every patient experiences pain differently. The same operation can feel very different to two people. Previous pain, anxiety, expectations, medical conditions, and past experiences with surgery can all affect what someone needs afterward. There is no single pain plan that works for everyone.

Before surgery, we should probably talk more openly about what good pain control really means. It does not mean promising, “You will feel no pain at all.” It means saying, “We will take your pain seriously. We will treat it. We will watch for side effects. And if the plan is not working, we will change it.” For many patients, a better goal is simple: enough pain relief to breathe comfortably, rest, move, and start recovering safely.

• Sometimes that means a nerve block.
• Sometimes it means several medicines working together.
• Sometimes an opioid is exactly the right treatment.
• Sometimes a small amount of manageable discomfort may be safer than repeatedly increasing medication just to make the pain score reach zero.

After surgery, perhaps we should not ask only, “What is your pain score?” We should also ask, “What is your pain stopping you from doing?” That answer may tell us much more about how well the patient is actually recovering.

Girishkumar Modi is an anesthesiologist in the United Arab Emirates.