What you need to know about PAIN     
     -A GUIDE for patients and families

Why Do We Experience Pain?
Why Should Pain Be Treated?
How Can We Work Together To Treat Pain?
What Are The Benefits Of Treating Pain?
How Do I Tell The Doctors And Nurses About My Pain?
Why Do We Feel Pain The Way We Do?
How Is Pain Treated?
What Are Some Ways That Pain Can Be Treated?
What Are Some Of The Medications Used For Pain?
What Are The Principles Of Treatment Using Medications?
How Are Pain Medicines Given?
Common Ways To Give Pain Medicine In The Hospital?
How Do I Use My Pain Medication Effectively?
When Are Long Acting Medicines Used?
What Are Breakthrough/Short-Acting Medications?
Tips For Using Breakthrough/Short-Acting Medicines?
What Do I Need To Know About Side Effects?
What Are Common Side Effects Of Opiates?
What Are Some Concerns About Taking Pain Medication?
What is Neuropathic (Or Nerve) Pain?
How Is Nerve Pain Treated?
What Are Complementary Or Alternative Treatments For Pain?
Other Complementary Or Alternative Therapies:
What Are Examples Of Social And Spiritual Interventions For Pain?
What is "Good" Pain Relief?

 

Why Do We Experience Pain?

Pain can be both a benefit and a curse. Pain is the body's way of warning that something is harming us. It urges us to take our fingers away from a hot stove or to pull the splinter out of our bare feet. A new pain in the abdomen may signal a problem with the appendix and helps us realize we need to seek medical care.

Why Should Pain Be Treated?

When pain is no longer useful as a warning, or when it continues past the time of recovery, then it may become a curse. Pain can become the problem rather than the warning.
Pain can interfere with our ability to sleep, to recover from an illness or operation, to enjoy family and friends and even to appreciate life in general. This type of pain needs to be prevented or controlled.

How Can We Work Together To Treat Pain?

We, your health care providers, ask that you help us provide good pain relief. We need you to tell us about your pain and how it responds to treatment. With teamwork, which includes your active participation, your pain can be properly evaluated and treated.
We need you to inform us when you are having pain, where it is, how bad it is and how if feels, and to let us know if the treatments are helping.

What Are The Benefits Of Treating Pain?

Uncontrolled pain has many possible negative effects including:

• slowed recovery from surgery, injury or illness
• loss of sleep
• decreased activity which can lead to blood clot formation in the legs and to general weakness
• depression, discouragement or fear
• pneumonia
• impairment of the body's immune system, which helps fight infection
• inability to participate in daily family life
• inability to work

How Do I Tell The Doctors And Nurses About My Pain?

Here are four descriptions about your pain that you need to share with your health care providers:

Step I: Tell us when you are feeling pain.

This sounds simple, but it is very important. We all show our pain in different ways. Only you can feel your pain. Other people, including your doctors and nurses, do not know what or how you feel unless you tell them.

Step 2: Tell us where you feel your pain.

You can have pain in more than one place in your body at the same time. Be sure to tell your health care providers all of the areas where you feel pain. Even if you think that a pain you feel has nothing to do with your main problem, pint it out.

Step 3: Tell us how bad the pain is.

No one but you knows how bad your pain is. No machine or test can measure the severity of pain. We really on you to tell us. You may be asked to rate the level of your pain on a number scale. A typical scale is from 0 to 10 where 0 stands for no pain, and 10 stands for the worst possible pain you could imagine.

Step 4: Tell us what the pain feels like.

Try to use words that describe what your pain feels like. People often use words such as "sharp," "stabbing," "shooting," "aching," "pins and needles," "burning," and so on. Use your own words to describe how your pain feels. These description may help your heath care providers understand and treat your pain more effectively.

Why Do We Feel Pain The Way We Do?

You may wonder why people with similar problems seem to feel different amounts of pain. When you "feel" pain, your brain is receiving a complex mixture of signals that all influence each other. The signals your brain receives may be different from those received by another person's brain.
Some reasons why we feel pain our own way may include:

• previous experiences with pain
• different beliefs about the meaning of pain
• genetic differences
• physical differences
• personality and mood
• other health problems that can make the pain lesser or greater

There is no right or wrong way to feel pain-you simply feel it the way you do.

How Is Pain Treated?

Medicines can treat many, but not all, causes of pain. There are many ways to treat pain in addition to medications. We may need to try several different treatment methods before we find the method or combination of methods that words best for you.
Our goal is to eliminate pain or at least reduce it enough to allow you to participate in daily life without a lot of discomfort or treatment side effects. However, complete elimination of pain is not always possible.

What Are Some Ways That Pain Can Be Treated?

Among the treatments and interventions that can reduce pain are:

• medications
• various types of anesthetic blocks
• complementary or alternative treatments
• social and spiritual support

What Are Some Of The Medications Used For Pain?

Common pain medications include:

Acetaminophen:

• Tylenol® and similar medications

Non-steroidal anti-inflammatory drugs (NSAIDS):

• Aspirin
• Ibuprofen (Motrin®, Advil®)
• Naproxen (Naprosyn®, Aleve®)
• Cox-2 Inhibitors (Vioxx®, Celebrex®)

Opiods (sometimes called narcotics):

• Codeine (Tylenol® #3)
• Oxycodone (Oxycontin®, Percocet®, Percodan®)
• Morphine (MS Contin®, Oramorph®)
• Hydromorphone (Dilaudid®)
• Fentanyl Patch (Duragesic®)

Local anesthetics (numbing medication):

• Lidocaine
• Bupivicaine (Marcaine®)

What Are The Principles Of Treatment Using Medications?

Using more than one kind of medicine often works best.
Example: Percocet is a mixture of two different medicines -oxycodone (an opiod) and acetaminophen (like Tylenol).

Even though two medicines may be similar, one may work better than another.

Example: You are given ibuprofen (Motrin®) for pain relief, but find it does not work well. Your medicine may be changed to naproxen (Naprosyn®), a similar anti-inflammatory medication, and this may turn out to work very well.

If one treatment does not work, another method may be tried.


How Are Pain Medicines Given?

You will be given pain medicines based on your needs.

Pain medications can be given:

• by mouth (tablets, capsules, liquids)
• through an intravenous line (IV)
• by injection (subcutaneous or intramuscular)
• absorption through the skin (a patch)
• absorption through the lining of the mouth
• rectal suppositories
• through catheters placed near the spine

Common Ways To Give Pain Medicine In The Hospital?

Patient Controlled Analgesia (PCA):

• It is often used after surgery.
• It delivers pain medication through and intravenous (IV) line, directly into the bloodstream (onset of pain relief in about 10 minutes).
• It allows you to receive a carefully controlled amount of pain medicine by pressing a button.
• It allows you some control over when you get your pain medicine.
• Your health care provider will decide how much medicine to give you based o your needs.
• It works faster than an injection into your muscle.
• It is computer controlled and very safe.
  

Epidural catheter:

• It is often used to deliver medication during surgery or during childbirth.
• It is a very thin, long, and flexible straw-like tube.
• It is placed into the back near where the nerves come and go from the spine.
• The placement takes about 30 minutes
• Medicine is pumped through the catheter and released near the nerves.
• The pump is set by the health care staff to administer the medicine at a safe rate.
• The rate can be adjusted to maximize pain control.
• The catheter may deliver an opiod, such as hydro morphone (Dilaudid), or an anesthetic agent, like bupivicaine, or both mixed together.
• The catheter is easy to remove and does not require a special procedure.
• Onset of pain relief takes 10 to 30 minutes.

Oral medications:

• They are the preferred rout for long-term therapy.
• They are usually given as pills or liquids.
• They often are referred to as PO medications (PO is a medical term meaning "by mouth").
• They start to work anywhere from 15 to 60 minutes depending on the kind of medicine.

Oral medications after surgery:

• They are started when you have recovered enough from surgery to start drinking or eating.
• A transition time may occur between starting oral medicines and stopping epidural or PCA medicines.
• Your health care team will decide when it is safe to use oral medications and will discuss this with you.

Transdermal medications (a patch):

• They are most commonly used in long term pain treatment.
• They are not recommended for use for immediate post-operative pain.
• They may be used if you are having difficulty taking medications by mouth (i.e. if you are unable to swallow or cannot remember to take your medication).
• Medicine is absorbed through the skin where it collects in the tissues. Fro it is slowly released into circulation.
• Once in place, the patch provides a continuous release of medication at a nearly constant rate for up to 72 hours.
• The patch needs to be in place for at least 12 to 18 hours before you will know its full effect.

Intramuscular/Subcutaneous:

• It is not commonly used but still a good choice in some situations.
• The medicine is injected in a muscle just under the skin.
• Onset of pain relief is in 20 to 30 minutes.

How Do I Use My Pain Medication Effectively?

You will be given directions on how to use your medication effectively.

Some medications are used on a regular schedule while others are used only if you experience a sudden pain problem or are about to engage in an activity that typically causes you pain.

Your medication schedule will depend on which medicines you are taking.

Example: Percocet® lasts from four to six hours, MS Contin® lasts eight to 12 hours, and the Fentanyl® patch lasts up to 72 hours.

Your provider will instruct you as to the appropriate schedule for using your medication.


When Are Long Acting Medicines Used?

They are used when pain continues at a fairly constant level over time.

Example: MS Contin, Oxycontin, Kadian, Duragesic

They should be used on a regular schedule (around-the-clock)

Medication given on a regular schedule provides a continuous level of pain treatment throughout the whole day.

What Are Breakthrough/Short-Acting Medications?

You might find that your pain level increases at times. Short-acting pain medications are used for this type of pain and are sometimes called breakthrough or rescue medicines (Percocet®, oxycodone, Ultram®).

• They are designed to last two to six hours.
• They are often used in combination with long-acting medications.
• They can be taken at the same time as long-acting medicine.
  Example: You can take long-acting medicine like OxyContin® at the same time as a short-acting medicine, like oxycodone, because they work at different speeds.
• They are sometimes used alone for pain that only occurs now and then.

Tips For Using Breakthrough/Short-Acting Medicines?

• Tell your health care provider how often you need to use the breakthrough medications in order to stay comfortable.
• If you need to use many doses of breakthrough medicine throughout the day, long-acting medication can be started or increased to control pain better.
• Take breakthrough medicine before the pain reaches a discomforting level. Usually you will need less medication to control your pain over the course of the day if you treat your pain as soon as it starts.
• Anticipate potentially painful events and take breakthrough medication about 30 to 40 minutes before the event occurs.

Examples of activities that might cause extra discomfort include:

• dressing changes
• physical therapy sessions
• moving onto and off of a stretcher
• walking

What Do I Need To Know About Side Effects?

• All medications, including non-prescription drugs like aspirin, may cause side effects.
• Some people experience side effects and others do not.
• Most side effects are not dangerous.
• Certain side effects will go away after a few days as the body gets used to the medication.
• Your health care provider will alert you tot he possible side effects of the medicines you are taking.
  
  

What Are Common Side Effects Of Opiates?

Constipation

Some medications may make it hard to pass stool from the bowel. This side effect is always possible with opiod medications. Treatment for constipation should always be part of the treatment plan if you are receiving opioid medications. Treatment for constipation should always be part of the treatment plan if you are receiving opioid medications.

How can I help control constipation?

• Drink plenty of fluids throughout the day.
• Eat a diet that includes fruits and vegetables.
• Exercise, such as walking, is also helpful.
• You may need to use a laxative for constipation (Everybody's bowel habits are different. Your health care providers will help you to understand the regimen that is best for you).
• Let your health care provider know if you do not have a bowel movement at least every few days.
  

Drowsiness

Medications, like opioids, can cause sleepiness or drowsiness.

• This side effect usually clears after two to three days of using the medicine.
• You must be careful not to drive or operate potentially dangerous equipment if you experience drowsiness.
• If the drowsiness continues, speak with your health care providers.

Nausea and/or vomiting

These side effects are most likely to occur in the first few days of using an opioid medication or after a dose increase.

• Speak with your health care providers if you get nausea and/or vomit.
• There are many good medications to help control these symptoms so that you can continue to use pain medications without felling sick.
• Nausea and vomiting need to be treated so that pain management can continue.

What Are Some Concerns About Taking Pain Medication?

Will I become addicted to the pain medication?

Simply using an opioid for pain relief does not mean you will become addicted. If you are using these medications for pain, you will be able to stop using them when your pain goes away.

Less than 1 in 1, 000 people will develop an addition problem with pain medications. Should 999 people have horrible pain because we worry about that one person? No Even if you do develop a problem with a medicine, we can help you.

Will the pain medication I am taking now still work later?

When you take pain medication over a long period of time, you may need higher doses of pain medication to maintain the same pain-relieving benefits. This is called tolerance. Tolerance has nothing to do with addiction You will be able to get the additional medication as needed to treat your pain over time. These medicines will continue to work.

What does dependence mean?

When you take certain medications over time, your body gets used to having the medication. If you stop medication suddenly, you may experience a variety of "withdrawal symptoms." These symptoms generally are mild and do not harm the body even though they can feel very unpleasant. Anyone can experience "withdrawal symptoms" if they stop their medication too abruptly.

How can I prevent withdrawal?

Withdrawal is easy to avoid by reducing the dose of your medication gradually over a period of several days. Your health care provider will give you a schedule for doing this and talk with you about how to stop taking your medication comfortably and safely.

Will treating my pain cover up other medical problems?

People sometimes worry that if their pain is treated, they will not know if something else goes wrong. We have learned that this almost never happen.

When a new pain occurs, people know if even if they are being treated for an already existing pain. There are very few circumstances under which health care providers can not use pain-killing medications right away when a person has pain.

What if the pain medicines do not provide me with adequate pain relief?

Your health care providers need to know how the medicine works for you. Just as pain does not feel the same for every person, medicines do not always have the same effect on every person. If you feel you need either more or less medicine, speak to your health care provider Do not make changes on your own.

What is Neuropathic (Or Nerve) Pain?

• Nerve pain lasts past the time of healing or starts weeks or months after an injury occurs.
• Nerve pain is different in some ways than the immediate pain of surgery or injury.
• Nerve pain is caused by changes that occur within the nervous system following an injury.
  
  

How Is Nerve Pain Treated?
All of the pain treatment medications mentioned earlier can be used to treat neuropathic pain, but there are other classes of medications that help to calm the damaged nerves that are sending pain messages.

These other medications include:

• anti-depressants (amitriptyline, desipramine)
• anti-convulsants (Tegretol, Dilantin, gabapentin)
• steroids (Decadron)
• anti-spasmodics (baclofen)
• anxiolytics (Ativan)

These drugs were originally (and still are ) used for purposes other than pain relief, but we have discovered that they also help control nerve pain.


What Are Complementary Or Alternative Treatments For Pain?

For many people, complementary treatments may be very helpful in reducing pain and suffering.

Some examples of complementary treatment include:

Relaxation

• appropriate for almost any type of pain
• goals include reducing muscle tension and anxiety
• techniques include deep breathing and guided imagery
• needs to be practiced
• requires you to be an active participant

Distraction

• consists of directing attention away from pain
• might include thinking about a happy event or listening to music
• most appropriate for use over a brief period of time, such as during a painful procedure, and for pain that is mild to moderate in intensity

Massage

• effects are usually soothing and relaxing, both physically and mentally
• requires little effort or expertise
• common areas of the body for massage are the back, shoulders, hands and feet

Other Complementary Or Alternative Therapies:

• heat packs
• cold packs
• prayer
• hypnosis
• positioning/body splintering
• positive thinking
• music
• laughter
• acupuncture
• TENS (Transcutaneoud Electrical Nerve Stimulation)

Caution: Treatments like heat and cold, acupuncture, massage, and TENS need to be done correctly and safely, because they have the potential to harm or increase pain if used improperly.

What Are Examples Of Social And Spiritual Interventions For Pain?

Pain is almost always better when we are happy, not bothered by physical discomforts, and engaged in activities that distract us from our pain.

Help us take good care of your pain by focusing on your mental well-being as well as all aspects of your physical condition.

Important social and spiritual interventions can include:

Social visits with family and friends

These visits often help to reduce pain and suffering through distraction and the healthful benefits of laughter.

Prayer or visits with clergy or spiritual guides

You may find solace in prayer or visits with clergy or spiritual guides. Please make your preferences clear about whether you wish to receive pastoral visits in the hospital. The chaplaincy office at the MGH is ready to assist you.

What is "Good" Pain Relief?

Our goal is to:

• work with you as a team to relieve as much of your pain as possible. We aim for complete relief.
• work with you to balance the pain relieving effects of medication with the possible side-effects of treatment.
• help you participate in activities of daily living without being distressed by pain.
  

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