Pain Management

We care about you and your pain relief.

This includes:

• Asking about your pain;
• Responding to your reports of pain;
• Developing a pain control plan with you; and
• Teaching you about medicines and your pain control plan.

 Pain relief is your right. You are the person who can best describe your pain. We will:

• Believe your report of pain. 
• Respond promptly.
• Address your concerns even though complete relief may not always be possible.

We will ask you to rate your pain.

At Lourdes, we use a 0 - 10 scale (0 = no pain; 10 = the worst pain imaginable).

If you do not understand this scale, please tell us so that we may meet your needs by using another rating system.

If you need us to read it to you or provide it to you in another language, please tell us so that you can take part in your care.

 

Taking Care of Pain is Important

Taking care of pain can help you feel stronger and cope better.

Pain can cause you to be: Tired Depressed Angry Worried Lonely Stressed

Pain can affect your:  Daily activities Interest in work & hobbies Sleeping Eating Home life Friendships

If You Are In Pain

Medicine and other treatments can often relieve pain. Treating pain is an important part of good health care. Talk to your health care team:

• To get relief as soon as pain begins.
• To develop a plan to manage pain.
• About worries you have about taking pain medicines.

We need you to partner with us to manage your pain well.

• Follow your health care team's advice.
• Help your health care team assess your pain.
• Learn how to take your medicines safely.

Be sure all the pain medicines you use, including over the counter ones, are on your medicine list.

Tell us:

• All the places where you are feeling pain.
• How strong the pain feels.
• What the pain feels like:

aching bloating burning cramping

comes & goes constant cutting dull

numbing pressing pressure pulling

radiating searing sharp shooting

soreness stabbing throbbing tightness

• What makes the pain better?
• What makes the pain worse?
• What pain medicine you now take?
• How well your current pain medicines work.
• If your pain is not relieved.

Ask:

• What can I expect about my pain and its control?
• What pain relief options do I have?
• What medicine(s) can you give me to relieve my pain?
• How and when should I take the medicine(s) and for how long?
• What side effects are common?  What should be done if they occur?
• Should I try non-drug methods to relieve my pain?  

Types of Pain

Acute Pain 

New pain that is short-lived. You know the cause. Think about what has gone on in your life:

• Surgery?
• A new exercise program?
• An injury?

Chronic or Persistent Pain is ongoing and:

• Lasts beyond the illness or injury - for at least 6 months
• Affects your well-being.
• More chronic pain information is available through the American Chronic Pain Association. The website is http://www.theacpa.org

Breakthrough or Flare-Up Pain

Pain that occurs even though you take routine pain medicine.

Pain Treatments

There are many ways to treat pain:

• Medicines
• Complementary and Alternative Treatments
• Invasive Treatments
• Non-invasive Treatments
• Behavioral Approaches

Medicines

Medicines are the most common way to treat pain.

• Always have a medicine list. Know the generic and trade names for your medicines. This reduces the risk of taking too much of the same medicine.
• Each person may respond in a different manner to any medicine. For some people, medicines may cause side-effects.
  • Always take medicines as prescribed to reduce the risk for side effects. 
  • Ask if the pain medicine:
    • Puts you at risk to fall.
    • Can impair your thinking. 
    • Will impair your driving or ability to work.
    • Causes constipation or nausea.
  • Tell your health care team if you are drowsy or have other side effects.

Types of Medicine for Pain

There are four major types of medicine:

Non-Opioids

Follow the directions on the label! Too much of these can hurt you.

• Acetaminophen (Tylenol®)
• NSAIDs such as aspirin, ibuprofen (Motrin®; Advil®), naproxen (Aleve®)

Opioids(Narcotics)

We want youtobe safe.Talk toyourhealth care teamaboutside effects!

• Your risk for problems from opioids is greater if you have risk factors. Tell your health care team if you have:
• • Sleep apnea or a sleep disorder
  • Lung, cardiac, or kidney problems
  • Obesity: your BMI is greater than 30
  • Age over 60 years

 These factors also put you at risk:

• You are taking other medicines that sedate you
• You do not use opioids often
• You have just had surgery that:
  • Involves your chest or abdomen
  • Lasted many hours
  • Store opioids in a secure place. You will reduce the risk of harming others by mistake
  • Opioids may include:
    • Morphine such as MS Contin®, Roxanol®
    • Codeine
    • Hydrocodone such as Vicodin®, Norco®
    • Oxycodone such as Percocet®, Oxycontin®, Roxicet®
    • Fentanyl such as Duragesic® patches

Adjuvants

Medicines used to treat other conditions have been found to help chronic pain. These may include:

• Antidepressants such as Celexa®, Paxil®, Lexapro®, Effexor®, Cymbalta®, Elavil®
• Anticonvulsants such as Depakote®, Tegretol®, Neurontin®, Lyrica®, Topamax®
• Muscle relaxants such as Flexeril®, Soma®, Zanaflex®

Medicines That Do Not Treat Pain Itself

These medicines may be prescribed as part of a pain treatment plan. These may include:

• Sleep aids such as Ambien®, Tylenol PM®
• Anxiety medications such as Xanax®, Ativan®
• Laxatives

Complementary and Alternative Treatments

• Complementary treatments are used with prescribed medications.
• Alternative treatments are used in place of prescribed medications. 
• Herbals and supplements are known as this type of treatment. Talk to your health care team if you use them.
• The NationalCenterfor Complementary and Alternative Medicine website is http://nccam.nih.gov 

Invasive Treatments

Used when first-line treatments do not control pain well.

• Injections into a joint or trigger point:
  • Steroids
  • Lubricating substances
• Spinal cord stimulation:  A neuro-stimulator is implanted under the skin and generates mild electrical signals
• Intrathecal drug delivery systems:  These devices deliver pain medication directly into the spinal cord and nerve roots.
• Nerve and facet blocks:  These destroy the nerve that supplies the affected area
• Acupuncture

Non-invasive Treatments:

Acupressure Chiropractic Education Exercise Heating pads Hyperbaric oxygen Ice packs

Immobilization Magnet therapy Massage Smoking Cessation Tai Chi TENS units Yoga

Behavioral Approaches:

• Counseling
• Guided Imagery
• Meditation
• Prayer
• Progressive Muscle Relaxation
• Relaxation
• Relaxation Breathing

Effects of Cigarette Smoke on Pain

Smoking causes blood vessels to become narrow. Narrow blood vessels result in:

• Less oxygen-rich blood flowing to areas of pain.
• Slower bone and wound healing.

Smoking triggers the release of substances that cause inflammation and make pain worse. Smoking also makes your bones weak. It puts you at risk for:

• Osteoporosis
• Spinal degenerative disease

Alcohol and Pain Medicine Do Not Mix

Talk to your health care team about using beer, wine, and liquor while on pain medications.

• Alcohol can add to the sedating effects of certain prescription drugs. 
• Alcohol can increase toxic side effects of acetaminophen (Tylenol®).

Illegal Drugs

Most illegal drugs increase your risk for harmful side effects when used with other medications. For your safety, tell your health care team if you use illegal drugs.

Myths and Facts

Don't let worries like these keep you in pain:

I don't want to seem like a complainer.

Fact:  Telling your health care team about pain is what all patients should do. It's often easier to control pain in its early stages, before it becomes severe. The sooner you speak up, the better. 

I don't want to lose control.

Fact:  Most people do not get "high" or lose control when they take pain medicines as prescribed. Tell your health care team if you feel dizzy, sleepy, or confused. Your dose or medication can be changed to help solve the problem.

I'm afraid of becoming addicted.

Fact:  Most people do not become addicted.

Talk to your health care team about how to use pain medicines safely.

Pain Management Resources

Compassion and Support - Pain Management Patient Guide from the Medical Orders for Life-Sustaining Treatment (MOLST).

American College of Rheumatology - The American College of Rheumatology (ACR) is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with arthritis and rheumatic and musculoskeletal diseases. The ACR provides various educational information for patients.

Effective Health Care - The Agency for Healthcare Research and Quality (AHRQ) was established in 1989 as the Agency for Health Care Policy and Research. Reauthorizing legislation passed in November 1999 establishes AHRQ as the lead Federal agency on quality research. AHRQ, part of the U.S. Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services. AHRQ's broad programs of research bring practical, science-based information to medical practitioners and to consumers and other health care purchasers.

National Cancer Institute - Pain Control Booklet - This booklet will show you how to work with your doctors, nurses, and others to find the best way to control pain associated with cancer. It will discuss causes of pain, medicines, how to talk to your doctor, and other topics that may help you.

National Diabetes Information Clearinghouse (NDIC) - Diabetic Neuropathies: The Nerve Damage of Diabetes - NDIC was established in 1978 to increase knowledge and understanding about diabetes among patients, health care professionals, and the general public. To carry out this mission, NDIC works closely with the National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK's) Diabetes Research and Training Centers; the National Diabetes Education Program (NDEP); professional, patient, and voluntary associations; Government agencies; and State health departments to identify and respond to informational needs about diabetes and its management.

National Fibromyalgia Association - The National Fibromyalgia Association is a nonprofit organization whose mission is: To develop and execute programs dedicated to improving the quality of life for people with fibromyalgia.

Mayo Clinic - Mayo Clinic's three main Web sites provide information and services from the world's first and largest integrated, not-for-profit group medical practice. Manage your health with information and tools that reflect the expertise of Mayo's 3,400 physicians and scientists, learn how to access medical services, and discover Mayo's medical research and education offerings.