|
|
|
|
|
|
|
|
Understanding Pain
Reviewed: December 2006
 One of the key principles of good pain management is open and honest communication with your doctor or nurse.
Patients and families often don't report pain, because they don't want to bother the doctor or nurse, and also because they may not want to appear to be complaining. Patients are often fearful of telling their health care team that they are having pain. They are afraid that if they use the strong medicines now there won't be any other medicines left to use later.
Fear of addiction (an emotional need for pain medication because of the feeling that is received from the medicine) and tolerance (drug is no longer effective at the present dose because the body had adjusted and now needs a higher dose) may interfere with proper use of pain control medications for many patients. A good plan for pain management outlined by your doctor,pharmacist or nurse helps you better participate in your treatment and will also improve your quality of life.
Many pain medicines are available to relieve your pain. If the pain medicines do not provide the relief you need, the doctor can increase your dose, or change your present medication and try to find one that works better for you.
When using the medication morphine (or it's relatives), it is important for you to know that there is no maximum amount of morphine that can be prescribed - if your pain gets worse, we can just increase your dose until you get the desired pain relief.
When assessing your pain, your care team will use a pain scale. This tool is helpful to allow all parties to have the same "pain language" to describe the intensity of your pain.
Description or Measurement of Pain
Each person has a different response to pain. At different times and under different circumstances you may feel varying levels of pain with the same illness. Communication with your health care team and family is necessary for best pain control. The use of a consistent pain scale (0 = no pain, 10 = worst pain imaginable) helps to best communicate the intensity of pain you are feeling.
|
Pain Intensity Scale |
| 0 1 2 3 4 5 6 7 8 9 10 |
| I I I |
| No Pain Moderate pain Worst Pain |
Take your medicines as prescribed. If they do not relieve your pain, contact your doctor or nurse. It is important to let your healthcare team know about your pain. A helpful way of recording is to keep a journal of your pain level and treatment and medications. It is important to tell your healthcare team members know:
- Where the pain is
- What it feels like: sharp, dull, achy, or tingly
- How long the pain lasts
- What helps the pain, what makes it worse
- What medications you are taking, how much and how long do they help for
- What things have you tried in the past that work for you (massage, heat, other medicines)
- All the medicines including prescriptions or over the counter medications you are taking (it is helpful to keep a written list in your wallet or purse)
Top
Types of Pain
The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage and/or described in terms of such damage."
- Acute pain is usually very painful, but lasts only a short time. This is generally a message that body tissue has been damaged, and the pain generously goes away as healing occurs.
- Chronic pain may be mild or severe and is present for long periods of time. People with chronic pain that is controlled by medications may have what is known as breakthrough pain. This can happen when pain increases or "breaks through" due to increased activity or for other reasons. This type of pain may occur even when the right dose of medicine is given.
Prevention
The best method to treat pain is to prevent it from recurring. Sometimes we cannot know when the pain will start, but we can try to prevent it from returning once it starts.
The following are a few rules of thumb to assist you in preventing pain:
- Be sure you take your pain medicines as prescribed. The best way to take pain medicines is on a schedule (e.g. every 4 hours, or 12 hours). Waiting until the pain returns means you will have to play "catch up." You may even need to take more medicine than if you treat the pain before it becomes a problem.
- Take pain medicines before any activity you know will bring on pain. This will allow you to be more active with less pain.
- Let your doctor, pharmacist, or nurse know if you are having side effects to the pain medicines. Most side effects can be easily treated.
You also can prevent some of the expected side effects to pain medicines.
- Most patients taking medicines will develop constipation. Take a laxative or stool softener (either as separate pills or in combination) every day to prevent constipation. As the dose of the opioid increases, so must the dose of the laxative and stool softener. See the section on constipation for further understanding of this uncomfortable symptom.
- Many patients taking opioids will have nausea and feel drowsy, particularly at the beginning of the use of the medication, or at the time that the dose is increased. Usually the nausea or drowsiness experienced disappears after a couple of days. Advise your health care team if these symtoms are severe and cannot be managed, or persist beyond two-three days of change in medication.
Top
Fears and Facts
1. Fear: Cancer causes intolerable pain, which cannot be relieved.
Fact: Some patients with cancer never have pain.
2. Fear: Patients who use opioids will become addicted.
Fact: Patients who take opioids for pain rarely, if ever, become addicted. Only one in 10,000 patients will become addicted.
3. Fear: If strong medications like morphine are used too soon, they will not work later if the pain gets worse - patients can become tolerant.
Fact: Strong medications like morphine stay effective as long as they are needed. If pain increases, the medication dose can also be increased as much as needed.
4. Fear: Strong pain medications, such as narcotics, have unpleasant side effects.
Fact: The most common side effects are drowsiness, nausea and constipation. Sleepiness and nausea usually go away after a few days. Simple treatments can control nausea and constipation.
5. Fear: Complaining about pain means you are not a "good" patient.
Fact: Doctors and nurses must know about all of a patient's symptoms, including pain, in order to give good care.
6. Fear: Talking about pain will distract the doctor from working to treat the cancer.
Fact: Pain relief is an important part of the cancer care. Pain can interfere with sleep and rest, which are important to the body's ability to fight disease.
7. Fear: Pain means that the cancer is getting worse.
Fact: Pain can be due to cancer or the effects of cancer treatment. Sometimes the pain is unrelated to the cancer.
8. Fear: "Shots" will be needed to control cancer pain.
Fact: At least 90% of cancer pain can be effectively relieved by simple medications that are taken by mouth. Other treatments can help the rest. "Shots" or injections are rarely necessary.
The BC Cancer Agency maintains a database on commonly used unconventional therapies available to cancer patients.
|
|
|