- What is pain?
Physical pain is the result of injury or disease to the tissues or nerves of the body. Once the injury occurs, the sensation of pain is transmitted through the nerves to the brain, letting the person know they have pain. The brain may instruct the person to do something protective. For example, when something hot is touched, the brain will send an impulse down the nerve to tell the person to move their hand away from what is hot, preventing further injury. Pain can only be described by the person experiencing it.
- What is the difference between acute and chronic pain?
Acute pain is a new pain that usually signals a serious condition. For example, right sided abdominal pain can indicate appendicitis; or, chest pain can indicate a heart attack. Pain lets the person know that medical attention may be needed. When the condition is corrected or the injury heals, acute pain subsides. Chronic pain is ongoing and the cause often cannot be corrected. Back pain and arthritis are common types of chronic pain.
- What are the different types of pain?
There are three main types of pain.
- Nociceptive pain arises from tissues, bone, and organs; for example, from a burn or broken bone.
- Neuropathic pain is the result of injury or disease to the nerves, such as shingles or carpal tunnel syndrome.
- Referred pain is felt in one part of the body but originates in another. Examples of referred pain include jaw and left arm pain when someone is having a heart attack, or right shoulder pain when someone has gallstones.
Some pain is a mixture of different types of pain. For example, back pain may be nociceptive because of arthritis in a vertebra and neuropathic because the disk between the vertebrae is pressing on the nerve causing pain to shoot down the leg.
- What is the best way to stop pain?
Many medications and other treatments can be used to treat pain.
Medications frequently used to treat pain include acetaminophen (more commonly known as Tylenol®), ibuprofen (Advil®), and stronger medications known as opioids. Examples of opioids include oxycodone and morphine. Antidepressants and seizure medications can be very helpful when treating neuropathic pain.
Non-medication (non-pharmacological) treatments are very successful at treating pain. Relaxation, distraction, and prayer are therapies that anyone can do. Some non-pharmacological treatments for pain require a trained practitioner. These include Reiki, acupuncture, biofeedback and physical/occupational therapy. Cold and heat may also help decrease pain, though they should be approved by the healthcare provider first to assure that they are used properly.
In some cases surgery, radiation, or chemotherapy may be used to decrease pain.
- Is pain medication automatically given in the hospital?
Not necessarily. There are two ways that pain medication may be ordered: as needed (called “PRN”) or at scheduled times (around the clock). In a hospital (as well as a rehabilitation facility or nursing home) the patient will need to ask for PRN pain medication. When the medication is ordered around the clock, it will be given on a routine basis.
- Why do some pain medications work longer than others?
The length of time that pain medications work varies.
Intravenous (IV) medication will work faster, but not for as long as medication in a pill that is swallowed.
Some pills are made so that they work very quickly (immediate release) and some will work over a long period of time (long acting). Also each medication is different in the amount of time that it will be effective, though most work over 4 hours.
Healthcare providers may order a long acting pain medication along with a short acting one.
- What are the side effects of opioid (narcotic) medications?
The most common side effects of opioid medications include nausea and vomiting; sedation; respiratory depression; and, constipation. Except for constipation, all of these side effects will last for a short period of time. They can be treated as needed. Constipation will continue as long as the person is taking an opioid, therefore prevention through daily laxatives is usually the best approach. There are some side effects of opioids that are seen only after the person has been on the medication for an extended time. These include changes in the immune system.
- Why is chronic pain harder to treat than acute pain?
Chronic pain can last for months, years, and possibly for the rest of a person’s life. It can lead to physical, emotional, spiritual, as well as financial distress. The person may be unable to enjoy or even participate in their life leading to: not being able to work; depression; decreased appetite; fatigue; and, impaired social interactions.
When pain lasts much longer, so will the need for pain medication. There are some side effects of opioids that are only seen after the person has been on the medication for an extended time. These include changes in the immune system.
Persons with well managed chronic pain can lead very productive and happy lives.
- Don’t people get addicted to pain medication?
Addiction is when a person craves a drug despite the harm that it’s doing to their body and life. When taken for actual pain, opioid pain medication rarely causes addiction, even when a person needs to take it for a long period of time.
People do become physically dependent to medications and this is different from addiction. Physical dependence means that the body becomes used to the medication and it cannot be stopped suddenly. This happens with other medications as well as opioids, for example, corticosteroids.
When an opioid is needed over time, it is likely that more of the medication will be needed to decrease the pain. This is called tolerance and is expected. It is not the same thing as addiction.
- Should pain medication only be taken when the pain is severe?
No, pain medication should be taken as ordered by the healthcare provider. Even a small amount of pain is too much and should be treated. Unrelieved pain can result in poor wound healing, decreased ability to move around, and decreased quality of life.
When a person waits until pain is severe to take pain medication, it is much harder to control the pain than if the medication had been taken all along. A chronic pain requires that a person routinely take pain medication so that it is in the body at all times.
- What is the best way to tell my healthcare provider about pain?
Try to use as many descriptive words as you can when you talk about your pain, for example: aching, sharp, burning, shooting, dull, throbbing, sore, stabbing, prickling. The way you describe your pain can help your health care practitioner identify its cause.
The healthcare provider may ask you to rate your pain at rest and during various activities on a scale from 0 (no pain) to 10 (the worst pain a person has ever felt).
- What is a pain management specialist?
When a pain is not responding to treatment, a healthcare provider may consult with a pain management specialist, who has advanced training in treating pain.
- When a doctor says that nothing more can be done, does that mean the pain can no longer be treated?
Often when someone says that “there is nothing more that can be done,” they mean that a cure or complete recovery is no longer possible. Palliative and hospice practitioners are educated in many ways of alleviating pain at the end of life. This can include pain medication and non-pharmacological treatments. There is always something that can be done to relieve pain.
- How can radiation therapy or chemotherapy help with pain at the end of life?
When a tumor has grown to a size that it is causing pain, radiation or chemotherapy can be used to decrease the size of the tumor, thus decreasing the amount of pain it causes.
- My mother always has pain – how can I help?
When someone has pain most of the time and has had it for many months, it is most likely a chronic pain. A physician or nurse practitioner who is very knowledgeable about the treatment of chronic pain can develop a treatment plan that will help your mother to do what she wants to be able to do.
In preparation for the appointment with the physician/nurse practitioner, write down when your mother has pain, where the pain is, and rate how bad the pain is. A rating scale of 0 to 10 can be used to describe the pain at different times or during different activities.
Once a treatment plan is in place, help your mother to stay on schedule with her medication and other treatments that may be prescribed. Make sure that her prescription(s) are refilled on time.
- My dad is in pain all the time, but thinks he can “tough it out.” How can I convince him that he doesn’t need to suffer?
There are many reasons why people choose not to take pain medication. Just a few examples include: fear of addiction; feeling that if they admit their pain then they are closer to dying; or even feeling the need to bear pain to make up for things they regret.
You and your father’s healthcare provider can assure him that addiction is not a concern when someone has pain.
Suffering extends beyond just physical pain and can be very complicated. You can ask your father if he wants to talk to you or someone such as a chaplain or social worker about why he feels the need to “tough it out.”
- What can I say to my dying sister who is suffering but refusing adequate pain medication because she is afraid she will no longer be alert?
Opioid pain medications can make someone feel sleepy when first started or when a dose is increased. This effect will go away over several days. The person may also be sleeping a lot because they are now comfortable and can rest. When the pain is so great that larger doses of opioids are needed, it can make the person less alert.
Balancing pain medication with wanting to be alert is a concern for many. Individuals can choose how alert they want to be. Some, like your sister, will choose to be able interact with family and friends over being pain free. Spend time talking with your sister as she may have things she wants to say to you or others before she dies. Also let her know that a plan can be worked out so that she has some pain control while still being alert instead of refusing all pain medication. Your sister may fear that pain medication will bring her death sooner. Assure her that the results of many studies indicate that opioids do not hasten death.
