Table of Contents

Introduction

An Informational Guide to Pain Management was developed by:

Susan Boulet, RN, MSN, OCN
Cancer Center Coordinator,
North Florida Regional Medical Center,
Gainesville, Florida

Dennis Martin, RN, BSN
Director Bone Marrow Transplant and Oncology Services,
Oklahoma University Medical Center,
Oklahoma City, Oklahoma

Reviewed by:

Pam Duncan, RN, BSN
Nursing Supervisor Ambulatory Surgical Unit
Oklahoma University Medical Center

Marie S. Johnson, ARNP
AVP Operations and Quality
North Florida Regional Medical Center

Lisa Madewell, RN, BSN
Clinical Manager Pediatric Oncology Inpatient Unit
Oklahoma University Medical Center

Julie T. Samples, ARNP, MSN
Assistant V.P. Nursing and Director of the Women's Center
North Florida Regional Medical Center

Please proceed to the Pain Management Guide.

View a glossary of terms..

View the resources for this guide.

Pain Management

All members of your health care team care about you and believe that you have a right to appropriate pain management. This information is offered as a tool to help you and your health care team manage your pain. This guide will explain:

• The importance of pain control.
• How pain relief impacts your recovery as well as your comfort.
• How you can take an active role in choosing options for treating your pain.

What is Pain?

Pain is a sensation that hurts. Pain is defined as whatever you, the patient, defines as pain. Pain occurs whenever and wherever you say that it does. There are two main types of pain:

• Acute Pain is a temporary pain that may be severe and is usually a signal that body tissue has been injured in some way such as a surgical procedure, burn, broken bone or other disease. The pain generally disappears when the injury heals.
  
• Chronic Pain ranges from mild to severe and may be present to some degree for long periods of time.The cause is not always known.It may be related to such things as arthritis, back problems, persistent headaches, or other problems or diseases.

How Pain Can Affect Your Lifestyle

Pain Can Cause:

• Tiredness
• Depression
• Anger
• Worry
• Loneliness
• Stress

Pain Can Interfere With:

• Daily activities
• Interest in work and hobbies
• Sleeping
• Eating
• Enjoying life
• Sexual activity

Important Notes About Pain

• Pain is always subjective.
• There are effective methods of reducing and relieving pain. Your healthcare provider can better help you if you tell them about your pain.
• Pain scales are useful tools to help you communicate pain intensity.
• Pain relief helps you better cope with an illness or injury.
• Well-controlled pain will enable you to do those activities, like walking and breathing exercises, that help you regain your strength and improve your overall recovery.
• Not all pain can be completely relieved; however, through communication with your healthcare team, an acceptable level of pain control can be achieved.

What Is Expected of You?

It is to your benefit to take an active role by:

• Asking what to expect regarding pain and pain management
• Discussing pain relief options with your healthcare team
• Working with your healthcare team to develop a pain management plan
• Asking for pain relief when pain first occurs
• Telling your healthcare provider if your pain is not adequately relieved

Describing Your Pain

Different types of pain may require different medications or other methods of relief. How do you describe your pain? It will help your pain management team if you can provide the following descriptions of your pain:

Location
Where is it? Does it spread or move to any other place? Can you point to it?

Quality
What does it feel like? For instance, is it sharp, dull, burning, searing, aching, cramping, shooting?

Intensity
Is the pain constant or does it come and go? This pain scale is a reliable tool to help you measure your pain and to set goals for relief. How would you rate the pain on a scale of 0 - 10? (0 being no pain at all and 10 being the worst you've ever had)

Other factors
How did the pain start? How long have you had this pain? What kinds of activities make the pain better or worse? Is it better or worse when you walk, sit, stand, lie down?

How Is Pain Relieved?

Medicine and other treatments can almost always can relieve pain. Most pain is relieved by two methods:

With Medicine

Medications prescribed by your doctor may be used alone or in combination with other medications to get good pain relief. Medications that are used to relieve pain can be given in a variety of ways, including:

• By mouth
• By rectum
• By injection or infusion
• By epidural catheter
• By skin patch

Patient Controlled Analgesia (PCA) is a method of giving pain medication using a machine that you control by pushing a button when you feel pain. Discuss this method with your doctor for more detail.

Pain medications that may be prescribed:

• Non-Opioids - e.g., ibuprofen, aspirin, acetaminophen. Some of these medications are used to relieve arthritic and minor pain because they help reduce inflammation; some can also reduce fever.
• Opioids - e.g., morphine, oxycodone, hydrocodone and codeine; these medications are usually used for moderate to severe pain. Some of these medications have a combination of aspirin or acetaminophen added to the tablets or capsules.
  
• Adjuvants - e.g., muscle relaxants, steroids, antidepressants, and anticonvulsants; may be prescribed to use in combination with pain medication to help relieve your pain.

If you have any side effects or allergies related to these or other medications, please tell your healthcare team.

Without Medicine

You may need help from health professionals to learn to use these techniques for yourself.

• Relaxation: Relieves pain by reducing muscle tension and anxiety. May include visual concentration, rhythmic breathing or massage.
• Distraction: The use of activity such as watching TV, reading, arts and crafts, etc. to refocus your attention away from the pain.
• Imagery: Uses your imagination to create mental pictures or situations - like a deliberate daydream.
• Skin Stimulation: The use of massage, pressure, friction, temperature change or chemical substances to relieve pain.
• Other Methods: May include surgery, nerve blocks, nerve stimulation, hypnosis, acupuncture, biofeedback, physical therapy, exercise and group therapy.

Pain Medication Tips

It is important for your healthcare team to know which prescription and non-prescription medications, alternative therapies or herbal supplements you take.

• It is a good idea to keep a current list of all medications in your wallet.
• It is also important to know how and when you take your medications.
• Some medications cannot be taken together.
• Your pain medication will work best when you take it on a regular schedule (by the clock).Taking medicine regularly, as your doctor tells you, will help keep the pain under control.
• Do not skip a dose of medicine or wait for the pain to get worse before taking your medicine.
• Ask your healthcare provider or nurse how and when to take extra medicine.If some activities make your pain worse, you may need to take extra medicine before these activities.
• The goal is to prevent the pain.Once you feel the pain, it is harder to get it under control.
• Treating pain is important and there are many medicines and treatments that may be used. If one medicine or treatment does not work, there may be another option that can be tried.
• Please remember to always keep medications in a safe place - out of the reach of children.

Questions to Ask Your Health Care Team

• What medicine(s) or treatments can you give me to relieve my pain?
• How often and when should I take the medicine(s) and for how long?
• What side effects are common? What should I do if they occur?
• Should I also try non-medicine methods to relieve my pain?

Questions Your Health Care Team May Ask You

• Where do you feel your pain?
• What does it feel like? Sharp? Dull? Throbbing? Steady? Burning?
• When did the pain begin? How often does it occur?
• How bad is the pain? Can you use a pain scale to rate your pain? For example, on a scale of 0-10 with 10 being the worst pain, how would you rate your pain?
• Does your pain prevent you from doing your daily activities? Which ones?
• What relieves your pain? What makes it worse?

Communicating Pain Relief

• Other than medication, is there anything that relieves the pain for you? How well does it relieve the pain? How long does the relief last?
• If you take, or have taken, medication for pain, is there anything that has relieved the pain for you? How well does it relieve the pain? How long does the relief last? How often do you take it?

Worried About Pain? Discuss Your Concerns

Please discuss your concerns about taking pain medicines with your healthcare provider.Your concerns might include:

Q. I am afraid I will become addicted.

A. When pain medications are taken the right way, patients rarely become addicted. Talk to your healthcare team about the safe use of pain medicines. Most patients only need pain medicine until the cause of their pain goes away. Follow your doctor's advice and get the pain relief you need.

Q. Will I seem like a complainer if I ask for pain medicine?

A. You have a right to ask for pain relief; in fact, the sooner you speak up, the better. It is much easier to control pain in the early stages, before it becomes severe.

Q. Will pain medications make me lose control?

A. Most people do not experience loss of control when they take pain medicines the right way. You may feel drowsy when first taking some medicines, but this should go away after a few days. Tell your doctor if you experience unpleasant side effects. Changing your dose or type of medicine may solve the problem.

Suggestions

If you have suggestions for improving your pain management, please share this information with your healthcare provider, they welcome your ideas and input. Your healthcare team wants to know if you are satisfied with your pain relief. You are the most important member of the team!

References