My mother-in-law had shoulder surgery yesterday for a torn rotator cuff. They are using a special device that allows her to control her own pain levels. Whenever she has pain, she pushes the button and gets a dose of pain reliever right into the joint. I notice she pushes the button much more often than she's supposed to. Should we say something to the doctor?

Doctors have found that pain control is a major key to success after orthopedic surgery. With less pain the patient is more likely to get up and move around. There's less chance of blood clots, infection, scarring, and other complications.

Patient-controlled analgesia (PCA) is a fairly new method used after surgery to help control pain. It does just what it says -- allows the patient to decide when the pain is no longer tolerable.

Most PCA devices are preprogrammed in several ways. First, when the button is pushed only a predetermined amount of drug is released. Second, most devices limit how much the patient actually gets. The device may be set to allow no more than one full dose per hour. When the patient pushes the button in between doses, nothing happens.

You can always discuss pain control with the nurses or doctors. Some things to keep in mind are that patients do get a certain placebo effect from pushing the button. In other words, even if no drug is released, the patient feels better because he or she thinks it's working.

Second, if your mother-in-law isn't complaining of excessive pain and she's getting out of bed and moving around, then she may not need anything else. But if her movement is impaired because of pain, then oral medications are often used along with the PCA.

If she can't sleep at night she may need a mild sedative. Find out from the nurse what's been ordered for her and let them know what you've noticed. Getting good pain control is important in the early days after surgery and helps ensure earlier discharge.