Pain management in adults
What is it?
Pain is your body's way of reacting to injury or illness. Everybody reacts to pain in different ways. What you think is painful may not be painful to someone else. But, pain is whatever you say it is!
What causes pain? Pain can be caused by many things, such as an injury, surgery, or a disease. Some pain is caused by pressure on a nerve, such as a cancer tumor. Other pain is caused when nerves are cut as in an accident or surgery. After an injury or surgery you may not want to move the painful part of your body at all. But, you may have pain because you are not moving this body part. Sometimes there is no clear reason for your pain.
What are the different types of pain? Pain may be acute or chronic.
- Acute pain is short-lived and lasts less than 3 months. Caregivers first work to remove the cause of the pain, such as fixing a broken arm. Acute pain can usually be controlled or stopped with pain medicine.
- Chronic pain lasts longer than 3 to 6 months. This kind of pain is often more complicated. Caregivers may use medicine along with other treatments, like self-hypnosis and relaxation, to help you learn to deal with chronic pain.
What is your pain like? Caregivers want you to talk to them about your pain. This helps them learn what may be causing the pain and how best to treat it. Tell caregivers your answers to the following questions:
- Where does it hurt? Where does it not hurt? Does the pain move from one area to another?
- How would you rate the pain on a scale of 1 to 10? (0 is no pain and 10 is the worst pain you have ever had).
- How does the pain feel? Try to choose words that tell caregivers what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, or crushing? Or is the pain stabbing, burning, dull, numb, or "pins-and-needles" feeling?
- When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?
- How often does the pain bother you and how long does it last?
- Does the pain affect your daily life? Can you still work in spite of the pain?
- Does the pain wake you from sleep?
- Do certain things or activities cause the pain to start or get worse, like coughing or touching the area?
- Does the pain come before, during, or after meals?
- Does anything decrease the pain, like changing positions, resting, medicines, or changing what you eat?
Why is pain control important? Pain can affect your appetite (ability or desire to eat), how well you sleep, your energy, and your ability to do things. Pain can also affect your mood (how you feel about things) and relationships with others. If caregivers can help you control your pain, you will suffer less and can even heal faster.
The best way to decrease pain is to treat the cause of the pain. Almost all types of pain, including cancer pain, can be controlled with medicine and other treatments. It may not be possible to get rid of your pain completely. But, it is possible to lower the pain level so you can live and be comfortable enough doing everyday things. You and your caregiver will work together to find what pain control treatments are best for you. Always tell your caregiver if the pain gets worse. Ask your caregiver if you want more information about any of the following treatments. Medicine:
Anti-Anxiety Medicine: This medicine may be given to help you feel less nervous. It may be given intravenously (IV), as a shot, or by mouth.
Anti-Nausea Medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). But pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
Pain medicine: You may be given one or more different types of pain medicine that affect the nervous system so you feel less pain. They work together so that less medicine is needed while getting better pain control than any single type of medicine. Pain medicine may not get rid of pain completely. But, it should keep it at a level that allows you to move around, eat, and breathe easily. Do not wait until your pain is too bad to ask for medicine. The medicine may not work as well at controlling the pain if you wait too long. Tell caregivers if the pain does not go away or comes back.
How can pain medicine be given? Following are the different ways pain medicine can be given depending on the kind of pain you have:
- By mouth: You may be given pills or liquid to swallow or you may be given a pill or liquid to put under your tongue. Pain medicine can also be given as a lozenge (LAW-zenj), like a cough drop or even as a special lollipop.
- Epidural (eh-pih-DER-ull): Medicine is given through a catheter (tube ) that caregivers put into the epidural space (the areas around the spinal cord).
- Inhaled: Medicine is breathed in through your mouth or nose.
- Nerve block: A shot of medicine is put close to the nerves in the area that hurts to break the pain cycle. The medicine makes the nerves unable to send pain messages to your brain. Nerve blocks give short-term relief of pain so that you can use the painful part and have a more normal life.
- PCA: A PCA is a device to give you pain medicine. PCA stands for patient-controlled analgesia (an-ull-G-z-uh). This is an electric pump with pain medicine that is connected through a tube to an IV (in your vein) or subcutaneous (subQ) (under your skin). You press a button when you feel pain and you receive medicine from the pump through the tube. Caregivers have set the pump so you cannot get too much medicine. A PCA pump works well to control pain because you can give yourself medicine before the pain gets too bad. Being in control of your pain relief also helps you relax and deal with the pain better.
- Rectal: Medicine in a suppository (suh-PAW-zih-tor-e) is put into your rectum.
- Shot: Pain medicine can be given as a shot in an IV, into a muscle, or subQ.
- Topical: Medicine in a cream or gel is spread over your skin.
- Transdermal: Some medicine can be given as a patch put on the skin. This medicine is released slowly to give pain relief for as long as 72 hours.
How can you take pain medicine safely and make it work the best for you?
Some pain medicines can make you breathe less deeply and less often. The medicine may also make you sleepy, dizzy, and unsafe to drive a car or use heavy equipment. For these reasons, it is very important to follow your caregivers advice on how to use this medicine.
Sometimes the pain is worse when you first wake up in the morning. This may happen if you did not have enough pain medicine in your blood stream to last through the night. Caregivers may tell you to take a dose of pain medicine during the night.
Some food, alcohol, and other medicines may cause unpleasant side effects when you take pain medicine. Follow your caregiver's advice about how to prevent these problems.
Pain medicine can make you constipated (hard BMs). Straining with a BM can make your pain worse. Do not try to push the BM out if it is too hard. Following are some things that you can do to deal with constipation.
- Eat more foods high in fiber. Some high-fiber foods are raw fruits and vegetables, whole-grain breads and cereals, dried fruits, popcorn, and nuts.
- Avoid hard cheeses and refined grains, such as rice and macaroni.
- Talk to your caregiver about drinking more liquids if you are not on a fluid restriction. Drinking warm or hot liquids can help make your bowels more active. Prune juice may also help make the BM softer.
- Caregivers may tell you to take fiber medicine to help make your BMs softer and more regular. This fiber medicine can be bought at any grocery or drug store. Ask your caregiver about taking a mild laxative (medicine to soften BMs).
- Walking is a very good way to get your bowels moving. Try to get up and around and do as much of your own personal care as possible. Talk to your caregiver before you start exercising so that together you can plan an exercise program.
Do not stop taking pain medicine suddenly if you have been taking it longer than 2 weeks. Your body may have become used to the medicine. Stopping the medicine all at once may cause unpleasant or dangerous side effects.
With time, you may feel that the pain medicine is not working as well as it did before. Call your caregiver if this happens. Together you can talk about changing your medicines or find new ways to control the pain.
Other non-drug pain control methods: There are many pain control techniques that can help you deal with pain even if it does not go away completely. It is important to practice some of the techniques when you do not have pain, if possible. This will help the technique work better during a pain attack.
- Acupuncture (ah-q-PUNK-sher) is based on the belief that life forces move through the body in specific paths. These paths are called meridians (mer-IH-d-uns). With acupuncture, a tiny needle is put into the meridian that runs to the area where you have pain. This needle blocks the meridian, which stops or decreases the pain.
- Cold and Heat: Both cold and heat can help decrease some types of pain after surgery. Some pain improves using cold while other pain improves with heat. Caregivers will tell you if cold and/or hot packs will help your pain.
- Distraction (dis-TRAK-shun) teaches you to focus your attention on something other than pain. Playing cards or games or talking and visiting with friends may relax you and keep you from thinking about the pain. Watching TV or reading may also be helpful.
- Guided Imagery (IH-mij-ree) teaches you to put pictures in your mind that will make the pain less intense. With guided imagery, you learn how to change the way your body senses and responds to pain.
- Hydrotherapy is a gentle water exercise program. It can strengthen muscles that are not injured and decrease inflammation (pain and swelling). Talk to your physical therapist or caregiver about hydrotherapy.
- Massage is often used to help a person relax. Have someone gently massage your back, shoulders, and neck. Massage can be even more effective if you also use guided imagery or breathing exercises.
- Music: It does not matter if you listen to music, sing, hum, or play an instrument. Music increases blood flow to the brain and helps you take in more air. It increases energy and helps change your mood. Music may also cause your brain to make endorphins which further decreases pain.
- Physical therapy can help pain caused by not moving one part of your body or after surgery or an accident. Stretching the muscles and making them stronger around the injured area can help the pain go away.
- Radiation can be used to decrease the size of a cancer tumor that is pressing on nerves and causing pain. Radiation can also help decrease bone pain.
- Relaxation and Biofeedback teach your body to respond in a different way to the stress of having pain. Normally, when pain starts, the body reacts by tensing muscles, heart beats faster, and blood pressure increases. Your breathing also gets faster and more shallow. These reactions can make the pain worse. Relaxation helps make the pain less by changing these responses. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed.
- Rest is when you stop doing the activities that cause you pain. Caregivers may have you do activities that use the same muscles but will not cause re-injury or a new injury. For example, a runner with a leg injury may be told to swim or bike while the injury heals.These exercises decrease stress and pain on the leg muscles but still keep the runner in shape.
- Self-hypnosis is a way to change your level of awareness. This means that by focusing your attention you can move away from your pain. You make yourself open to suggestions, like ignoring the pain or seeing the pain in a positive way. It is not known exactly how hypnosis helps pain. But, it can give long-lasting relief of pain without affecting your normal activities. Self-hypnosis gives you better control of your body. You may feel less hopeless and helpless because you are doing something to decrease the pain.
- Surgery may be done to stop chronic pain. Caregivers may do surgery to cut the nerves to the painful area. The goal of this surgery is to stop the pain without losing feeling or movement in the area. In some people, the pain can come back after surgery or the pain may even be worse. For these reasons, surgery is usually not considered until all other pain control treatments have been tried.
- TENS is short for transcutaneous (trans-q-TAIN-e-us) electrical nerve stimulation (stih-mew-LA-shun). A TENS unit is a portable, pocket-sized, battery-powered device which attaches to the skin. The TENS unit uses mild, safe electrical signals to help control pain.
- Spinal Cord Stimulation is a nerve stimulation technique that is similar to TENS. The difference is that in SCS, an electrode (a metal wire) is put near the spinal cord during surgery. SCS also uses mild, safe electrical signals to help control pain.
Herbs and Supplements:
Before taking any herbs or supplements, ask your caregiver if it is OK. Talk to your caregiver about how much you should take. If you are using this medicine without instructions from your caregiver, follow the directions on the label. Do not take more medicine or take it more often than the directions tell you to. The herbs and supplements listed may or may not help treat your condition.
- Boswellia (Boswellia serrata) has been used for many years, but has not been studied in people who have pain.
- Capsaicin cream (Capsicum frutescens) from the cayenne pepper, applied to the skin over the affected area, can help pain. Initial applications are irritating but after the first couple of weeks the irritation goes away. Wash your hands carefully after using the cream to prevent it from going into your eyes.
- Devil's claw (Harpagophytum procumbens) has been used for many years, but has not been studied in people who have pain.
- Kava - kava (Piper methysticum) has been used for many years, but has not been studied in people who have pain.
- Turmeric (Curcuma longa) has been used for many years, but has not been studied in people who have pain.
- Valerian (Valerian officinalis) has been used for many years, but has not been studied in people who have pain.
- Willow (Salix alba) has been used for many years, but has not been studied in people who have pain.
- DMSO has been used, but has not been studied in people who have pain.
- D-Phenylalanine has been used, but has not been studied in people who have pain.
- Acupuncture may help pain.
- Biofeedback may help you manage your pain.
- Exercise may help your pain.
- Guided imagery teaches you to put pictures in your mind that will make the pain less intense.
- Massage is often used to help a person become more relaxed.
- Meditation may make it easier for you to deal with the pain.
- Movement re-education includes therapies such as Alexander Technique, Feldenkrais, Trager, and others that help you correct abnormal posture and biomechanics.
- Relaxation therapies can be different for each individual. For some people, aromatherapy is a good way to relax. Listening to music, sitting with a pet, singing, yoga or breathing exercises may work well for other people. Use whatever technique works best to relax you and keep you from thinking about the pain.
- Spinal manipulation may help pain.
Other ways of treating your symptoms : Other ways to treat your symptoms are available to you.
Talk to your caregiver if:
- You would like medicine to treat pain.
- You have a new pain or the pain seems different than before.
- Your symptoms have not gone away or improved by these self-help measures.
- You have questions about what you have read in this document.
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
1. Carpenter DM & Nelson BW: Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exerc 1999; 31(1):18-24.
2. Chrubasik S & Eisenberg E: Treatment of rheumatic pain with kampo medicine in Europe. Part 1. Harpagophytum procumbens. Pain Clinic 1999; 11(3):171-178.
3. Elkayam O, Ben Itzhak S, Avrahami E et al: Multidisciplinary approach to chronic back pain: prognostic elements of the outcome. Clin Exp Rheumatol 1996; 14(3):281-288.
4. Ernst E & Pittler MH: Experts' opinions on complementary/alternative therapies for low back pain. J Manipulative Physiol Ther 1999; 22(2):87-90.
5. Ernst E & White AR: Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med 1998; 158(20):2235-2241.
6. Flor H & Birbaumer N: Comparison of the efficacy of electromyographic biofeedback, cognitive-behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain. J Consult Clin Psychol 1993; 61(4):653-658.
7. Lincoff NS, Rath PP & Hirano M: The treatment of periocular and facial pain with topical capsaicin. J Neuroophthalmol 1998; 18(1):17-20.
8. Mathias BJ, Dillingham TR, Zeigler DN et al: Topical capsaicin for chronic neck pain: a pilot study. Am J Phys Med Rehabil 1995; 74(1):39-44.
9. Robbins WR, Staats PS, Levine J et al: Treatment of intractable pain with topical large-dose capsaicin: preliminary report. Anesth Analg 1998; 86(3):579-583.
10. van Tulder MW, Cherkin DC, Berman B et al: The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 1999; 24(11):1113-1123.
Last Updated: 12/4/2015