Pain
How to Express Your Pain and How We Plan to Manage It
Introduction
Pain is often an important symptom and commonly brings patients to
seek care. Questions about the characteristics of your pain are
important to help caregivers diagnose your illness and outline a
treatment plan. Details such as where the pain is, what makes it better
or worse, or trying to describe the feeling of the pain can all be
useful in determining the cause of pain. You will be asked to provide
this information to your doctors, nurses, licensed practitioners,
pharmacists, and other healthcare professionals – as a group, we will
refer to them as your ‘care providers.’ You may expect to be questioned
in all settings – the clinic, Emergency Department, on admission and, if
necessary, during your hospitalization.
Once you are under care we need to treat your pain symptoms. We
recognize that there are certain aspects of your care that will continue
to be uncomfortable (blood draws, injections) but our goal is to do
everything to minimize any unnecessary discomfort. For example, you can
be given sedation during procedures such as a colonoscopy. We will
discuss your pain control options before any procedure or surgery.
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The Benefits of Treating Pain
Pain can interfere with many things: our ability to sleep, recover
from an illness or operation, enjoy family and friends and even
appreciate life in general. These effects should be prevented or
controlled. There are also specific complications related to the pain
itself, which we hope can be avoided by treatment. We want to prevent
things like pneumonia after stomach or chest surgery, blood clots due to
inactivity (because moving hurts too much), impairment of the body's
immune system (which helps fight infection) and even depression,
discouragement or fear.
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How to Express Your Pain
Pain is unique because it is subjective – based on how you feel.
Unlike a temperature or blood pressure, which can be measured by instruments,
we have no direct measuring devices to judge the severity of pain or the
effect of treatment that we order.
You must tell us how ‘bad’ it is, and words such as “bad,” “very
bad,” “mild,” and “severe” may mean different things to different
patients, and even to your care providers.
In order to avoid problems with words, we will try to ‘measure’ your
pain using a pain scale. We feel that these scales can help clarify the
amount of pain you feel and help us to adjust your treatment.
Two types of pain scales are described below.
One scale is numeric, with “0” representing no pain at all and “10”
being the worst pain you can imagine. This scale can help your care
providers determine the effect the treatment had on your pain because
you can tell us your pain number before and after you take pain
medication. Pain numbers are also useful for chronic pain when you
and your care provider see each other over longer periods of time.
Repeated assessments help your care provider appreciate what a
particular number means to you about the level of your pain.
Numerical Scale |
 |
Another scale for indicating pain is useful if you are unable to
talk. It is called the Wong-Baker FACES Pain Rating Scale:
Hockenberry, MJ, Wilson, D: Wong’s
Nursing Care of Infants and Children, ed. 8,
St. Louis, 2007, Mosby. Reprinted with permission. Copyright Mosby.
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How We Plan to Manage Your Pain
For patients with no pain or just a bit of pain, no treatment is
needed. When your pain increases beyond this point and you decide to
take something for it, you may wish for clarification on the different
name brand products. Hospitals use acetaminophen (e.g., Tylenol®) or ibuprofen (e.g., Motrin®
or Advil®) for muscle, joint, bone pain or after small operations. For
higher levels of pain, other medications such as combinations of
these medications with an opioid (e.g., Percocet®, Vicodin®, Dilaudid®) may be used.
These medications may be given by injection, through a pump (Patient Controlled Analgesia or PCA) or by sustained release pills and
patches. Everyone responds to pain and pain medications differently.
Depending on your response, your care provider can increase or decrease
the dose of the medication, the frequency at which you can take
it, or both. Together, you and your care provider will be able to
decrease your pain level.
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An In-depth Approach to Chronic Pain
Many diseases such as arthritis and cancer are
associated with pain. Injuries or illnesses also may be accompanied by
persisting and lingering pain. These types of pain are often complex and
your care providers need
a lot of information from you in order to find the right medication, how
much you should take, and how often you should take it.
Your care provider may ask you questions
like: |
- Tell me, where is your pain?
- What does it feel like?
- Is it constant or does it come and go?
- What makes it worse or better?
- Have you taken anything for it?
- Did it help?
- Have you ever seen a pain specialist?
- If yes, do you continue to take the medications that the specialist
prescribed? What is your pain score when the pain is worst?
- If you have taken or tried something to relieve it, what is your score
an hour or so after the medication?
- Is that level tolerable to you or do you need more relief to be
comfortable?
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- If you feel you need more relief, then that is the goal we will work
toward.
- Have you ever used street drugs or alcohol to relieve your pain?
- Have you ever been treated for substance dependence?
- Have you felt nauseated?
- Have you vomited?
- Do you have trouble moving your bowels?
- Or urinating?
- Do you have any allergies?
- Are you itchy?
- Do you feel sleepy or have trouble thinking?
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There are strong links between physical pain and depression. Pain is
a common symptom of depression but, unfortunately, both care providers
and patients can miss the link between the two. Frequent headaches, back
pain, joint pain, and abdominal pain are the most common symptoms of
depression.
The severity of your symptoms relates to both the severity of the
depression and its effect on your quality of life. Being in chronic pain
also is very depressing so the two feed on each other.
Pain is often but not always caused by a specific illness or disease. If a cause is
not found after an evaluation, we will change our goal from finding the
cause to treating the pain. We will ask you to try and change your
focus, too, from seeking a cause to coping with the reality of having
medically unexplained symptoms. We have found that after patients
consider their symptoms and depression from this point of view, a
surprising number of them seem to understand and accept that they have
two problems, pain and depression. That realization is the first and necessary step to resolve both. A successful treatment plan in cases
where both are present must include treatment for the depression.
These questions are another important
part of the chronic pain evaluation: |
- Is your pain getting you down?
- Are you being treated for depression?
|
- To what extent do you think your pain contributes to your depression?
- Do you feel like you are suffering?
|
We are a team. Together let’s try and lower your pain in half as our
first goal. You need to keep record of your pain so that we can help
you. Please
download and print a copy of the
Pocket Reference for Pain Management (PDF).
Because you have been having pain for a long time and have had
difficulty getting relief as an outpatient, we expand our team approach
beyond the Health Center.
Here are other points that may be
covered: |
- Please tell me which pharmacy you will use to get your prescriptions
filled.
- You should use only one pharmacy for your pain medications.
- We will discuss your pain treatment plan of care with the pharmacist,
with your permission, so we can get to the goal as quickly and safely as
possible.
- Remember to keep taking your medications at the prescribed times.
- Don’t wait too long and let your pain level increase above your goal
because it will take longer to control your pain again.
- Severe pain is harder to treat.
- If you know a certain activity or position makes it worse, then avoid
them.
- If you can’t avoid them, try to take a dose of your medication
at least an hour before that activity.
- Keep your medicine away from children or others who might be attracted
to these drugs for non-medical use.
- If you are taking morphine or another opioid for longer than two to
three days, you also must take something for constipation (senna or Senokot®).
|
- The constipation will last as long as you are taking the medication so
please keep taking the laxatives.
- If you have never taken stronger pain medication before, don’t drive,
make important decisions or operate machinery until we know how you react.
- In the pain journal, write down all your concerns related to your pain.
- Call in 24 to 72 hours if you have any questions or concerns.
- We keep your treatment plan in your chart for all your care providers to
see.
- If six doses in 24 hours do not control your pain, call to discuss further
options.
- Do not change your pain medication regimen on your own.
- Also, pain makes a person tired. Don’t be surprised if, once you become
comfortable, you sleep a little bit more for next one to two days – it is not
overmedication, but peaceful sleep.
- Call us all with concerns!
|
We will work closely with you to find a regimen that helps you to be
as comfortable as possible. A successful regimen often goes beyond
medications and might include physical therapy and other treatments, such as distraction (music or visual), acupuncture,
therapeutic touch (Reiki and Transformative Energy), clinical nutrition,
homeopathy, and herbal medicine. Please ask if you are interested in any
of these.
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Your Pain Care Rights and Responsibilities
Every person in every situation has certain rights when it comes to
pain. We also believe that you need to help us to make treatment
effective – therefore, you also have certain responsibilities.
As a person with pain, you have the
right to: |
- Information about pain and pain relief measures.
- Have your report of pain taken seriously and to be treated with dignity
and respect by your care providers.
- Have your pain thoroughly assessed and promptly treated.
- Be informed by your care provider about what may be causing your pain,
possible treatments, and the benefits, risks, and costs of each.
- Participate actively in decisions about how to manage your pain.
|
- Have your pain reassessed regularly and your treatment adjusted if your
pain has not been eased.
- Get clear and prompt answers to your questions.
- Have time to make decisions.
- Accept or refuse any treatment, such as medications, tests, and
procedures, including the right to refuse pain medications.
- Be referred to a pain specialist if your pain persists.
- An appropriate pain management plan to use at home.
|
As a person with pain, you have the
responsibility to: |
- Ask your care provider what to expect regarding pain and pain
relief options.
- Ask for pain relief when pain first begins.
- Help your care providers assess your pain and tell them if the pain is
not relieved.
- Tell your care providers about any worries you have about taking pain
medication.
- Tell your care providers if you have side effects.
|
- Be open and honest with your care provider.
- Ask questions; keep notes and write them down.
- Have your pain medication prescriptions written by a single care provider and
filled at one pharmacy.
- Request refills with at least 48 hours notice before running out.
- Make sure you understand the dose and dosing instructions – if you do
not, we rely on you to ask.
|
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How Are We Doing?
We hope that this information helps us to understand your pain and
provide excellent treatment for you with minimal or no pain as the final
goal. We need to find out how we are doing! At some later date, you may
receive a survey from Press Ganey about your in-patient or out-patient
experience. We would appreciate it if you would complete the survey so
that we can use the information to provide the best possible pain
management for our patients. The survey includes these questions:
- During this hospital stay, did you need medication for pain?
Answer choices: Yes or No
- During this hospital stay, how often was your pain controlled?
Answer choices: Never, sometimes, usually, always
- During this hospital stay, how often did the hospital staff do
everything they could to help you with your pain?
Answer Choices: Never, sometimes, usually, always
The responses to these questions are reviewed and the results
communicated throughout the Health Center. We hope to improve
continually in the diagnosis and management of your illness, especially
related to pain.
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Refusing Pain Medications
Some patients may decide to refuse pain medications. Before deciding to forego treatment
for your pain, you
should consider the following points. Treating pain effectively can help
improve your function and ability to be independent. Unfortunately,
common misinformation about pain medications and their effects have
caused some patients to worry unnecessarily. Some fear that taking any pain medication may create a
dependency – not true. The risk of addiction is very small. While all medications, even pain medications, can
have side-effects, these side effects can often be minimized by reducing the amount of
the medication that you take. Some side effects last for just a few days
and then go away. You can be treated for these side effects during
that time. Side effects may be avoided by changing the way that you take
the medications. Often, you may have a side effect to one type of
medication but not to an equivalent medication. Patients may refuse pain medications
because of a belief that pain is ‘normal’ after an operation. While pain
may be caused by an operation, relief can also be considered ‘normal’
treatment. Some patients have religious or spiritual beliefs that value pain. You
may want to discuss your beliefs with your care provider or with our
chaplain. Ultimately, if you prefer not to have your pain treated, we
will respect your right to refuse pain medications.
If you have taken certain pain medications in the past and had
side-effects that you did not like, such as constipation or clouded
thinking, you should tell your care providers. These responses may not
be a true allergic reaction to the medications and need to be discussed in order to avoid or minimize them. It
should be possible to find a solution that avoids the side effects yet
still allows for treatment of your pain. Some patients who have
decided they don’t wish to receive pain medications sometimes tell their
care providers that they are allergic to the medication. We hope that
after you read this information, including your rights and the
definitions below, that you will feel comfortable about discussing any
problems you might have about the pain medications with your care
providers.
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Definitions of Medical Terms Used About
Medications
There are a number of commonly used words, which have special medical
meanings when applied to medications. You should know the correct
meanings as, loosely used, they can be misleading
Tolerance occurs after a long time and means that the effect
of the medication is not as great as it was in the beginning. A higher
dose of medication can then be ordered to relieve the pain. A different
medication may be substituted to relieve your pain.
Physical dependence occurs over a long time because the body
“gets used to” having the medication. Dependence can occur with opioids.
If the medication is no longer needed, it should be gradually decreased
over time. Stopping suddenly may cause symptoms, called a withdrawal
syndrome.
Addiction
Some patients are afraid that they will become addicted to pain
medications. Addiction to prescribed medications happens rarely.
The hallmark of true addiction is evidence of adverse life consequences.
Social and family relationships are harmed while work and recreational
activities are given up or decreased. The person continues to use the
medication, even though it is causing harm.
Allergies
Ordinarily, medications may act on your disease or symptoms without
affecting
your body. If your body does react, it is called
an allergic reaction. Your body releases histamine,
among other responses. The histamine causes itching, minor skin rashes
and hives in mild cases. There are more severe reactions, such as asthma
and anaphylactic shock. Severe reactions need immediate treatment, and
even minor reactions such as itching or hives may be treated to ease the
discomfort. The important point about allergies
is that the reaction is acquired – it does not occur the first time you
take a medication. It is not caused by the medication itself but
by the reaction of your body’s immune system.
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Common Side Effects of Pain Medications
Side effects are directly caused by the medications. They are common
and should not be confused with allergies, which as we saw are the
body’s reaction to the medication. You should know what side effects to
expect and how to manage them. When some side effects don’t go away, it
may mean that the treatment should be changed. Please tell us!
Constipation
This accompanies long-term use of pain medications. You will
need to take a stimulant laxative and possibly a stool softener (e.g., sennosides and docusate (Senna-S® is the combined product)) on a regular
basis. Be sure to talk about this with your care provider. Stimulant
laxative therapy is indicated for almost every patient who must take
opioids.
Nausea / Vomiting
These occur during the first three to five days of treatment or after a dose
change. They usually resolve on their own. If you have severe problems,
you should talk to your care provider for treatment, rather than waiting
for the problems to resolve.
Sleepiness / Sedation
You may feel drowsy or not able to think clearly. If these effects
occur, do not drive or use any equipment that may cause harm until they
go away. These effects usually last about three to five days. Also remember
that pain can be exhausting. Once we can decrease or relieve it, you may find yourself sleeping more for a day or two; in this
case, you are not overmedicated, but enjoying peaceful sleep.
Itching (Called Pruritis)
Itching does not mean that you are allergic to the medication; it is a
side effect that usually goes away in four to seven days. An antihistamine like diphenhydramine (Benadryl®) may help, but may also make you feel drowsy
as well.
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Social and Spiritual Resources for Pain
Pain almost always subsides when you are happy, free from physical
discomfort, and engaged in activities that help you look beyond the pain.
We would like to be attentive to all aspects of your pain, focusing not
only on your physical condition, but also on your mental, emotional,
social and spiritual well-being. Visits with family and friends often
help to reduce pain and suffering because the presence of our loved ones
reminds us that we are not suffering in isolation. They are with us to
share in all that we are experiencing. Similarly, for some people,
prayer is a reminder of God’s presence with them in their suffering. You
may find solace in prayer or you may simply wish to speak with someone
about your spiritual concerns. If so, please ask for a visit from one of
our chaplains. They will be happy to spend time with you or, if you
prefer, they can arrange for a visit from your own pastor or spiritual
guide.
We hope that this information will help you understand pain, how to
express it and how we plan to manage your pain. Our goals are to relieve
as much of your pain as possible, work with you to balance the pain-relieving effects of medication with the possible side-effects of
treatment, and to help you participate in activities of daily living
without being distressed by pain. We hope that this information assists in the achievement of
these goals.
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Medical Questions?
Healthnet: 860-679-4055 |
Looking for health information? Healthnet: Connecticut Consumer
Health Information Network, a program of the Lyman Maynard Stowe Library
at the Health Center, can help. Healthnet is a free research service to
Connecticut residents who have medical questions related to a personal
concern. Here’s How the Program Works
- You call
Healthnet at 860-679-4055 with a medical question or
questions.
- Your questions are answered by experienced, consumer
health librarians who use the complete resources of the
medical school library, including online databases, medical
textbooks, and Internet resources, to put together an
up-to-date information packet based on your individual
needs.
- The information will be mailed to your home or will be
available to be picked up at the library.
- It’s
important to note that the librarian will provide
information only, not medical advice or opinion.
For more information, visit
the Healthnet web site. Here, you will find a list of
resource guides on topics such as aging, navigating the healthcare
system, children’s health, mental health, and more. These resource
guides have recommended books, organizations to contact, and Internet
sources on the topic. There’s also a list of recommended Internet sites
on more than 25 topics to use if you want to do your own research. |
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Helpful Links
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