Controlling Acute Pain

Pain Management Subcommittee of Pharmacy and Therapeutics Subcommittee
University of Iowa Hospitals & Clinics
Peer Review Status: Internally Peer Reviewed
Creation Date: October 2001

What is chronic pain?

Pain is an uncomfortable feeling that tells you something may be wrong in your body. It is a very personal response that is both physical and emotional. Pain may occur suddenly or come about slowly. It may range from mild to severe. You are the best judge of your own pain.

Importance of pain control

Relief from acute pain is very important. It may help your recovery. After surgery, a medical procedure, or an injury, you may still have pain. However, your pain can be lessened. When your pain is treated, you will be able to move better. Your exercise may be easier to do. You will recover your strength faster.

Measuring your pain

We need your help to find out about your pain. This will help us provide the best treatment. Your doctors and nurses will ask questions to better understand your pain. We believe you when you say you have pain. We need you to tell us about your pain to decide on the best treatment. We will do our best to help you become more comfortable.

Here are some of the questions your health care team may ask you:

• Where is your pain?
  Point to any area on your body where there is pain.
• What does the pain feel like?
  Use your own words to describe your pain. Examples of words that may help you describe what you are feeling are :cramping, pressure, burning, tingly, numb, shooting, sharp, aching, or throbbing.
• How much does it hurt?
  You will be asked to describe or rate your pain using one of the following three methods: Number scale that uses numbers from 0-10; Word scale that uses words; Face scale that uses pictures.

Pain Scales

Number Scale
Describe your pain using a number from 0 to 10:
0= No Pain and 10= The worst pain you've ever had.

Word Scale
Describe the pain using the words that best tell us how much you hurt:
No pain; Mild; Moderate; Severe; Very severe; or Worst possible pain.

Faces Scale
Place an X or point to the face that shows how much you hurt:

May be duplicated for use in clinical practice. As appears in McCaffery M., Pasero C.: Pain: Clinical manual, p.67, 1999, Mosby, Inc.

Preventing Pain

Sometimes it is better to give pain medication before it starts to hurt. For example, your doctor or nurse may ask you to take pain medication before you have a test or before exercising. If you notice that a particular activity makes your pain worse, let the doctor or nurse know right away. It is easier to treat pain early - when you have the first signs of pain. You may receive pain medication at bedtime. This may prevent pain from disturbing your sleep.

Treating your pain with medications

Medications that stop or ease pain are called analgesics. They may be needed for many days after surgery or injury. After some minor injuries or procedures, they may not be needed at all.

Talk to your health care team about side effects from pain medication. Never take more that the dose ordered by your doctor. If you experience side effects, your doctor or nurse may be able to change the dosage.

Selecting the right pain medication

Your health care team will consider the following conditions when selecting the right pain medication for you:

• The type of pain you have
• Which medications work best for that type of pain
• The pain medications that have worked well for you before
• Problems you have had with certain medications
• Other medications you are taking, including vitamins and herbs
• Health care problems you may have
• Allergies you may have

Some pain medications commonly used include:

1. Acetaminophen - Commonly known by its brand name, Tylenol. It takes care of mild to moderate pain. It usually has very few side effects.
2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) - Aspirin and ibuprofen (Motrin), are some NSAIDs you may know. They are commonly used to reduce or prevent swelling. Some NSAIDs are available only by prescription. Others can be purchased over the counter. NSAIDs may not be the best choice for everyone because of some of their side effects.
3. Narcotic Analgesics - Also called opiates. These include morphine, hydromorphone, meperidine, codeine, and oxycodone. Some narcotics are commonly combined with acetaminophen. These include Tylenol #3, Percocet, and Lortab. Narcotics are available only by prescription. Side effects may include drowsiness, stomach upset, nausea, itching, and constipation. Stool softeners or laxatives may be given if narcotics are used for more than a few days. Don't drink alcoholic beverages while taking narcotics.

How are pain medications given?

Pain medications are given several ways. They may be given by mouth, or through the nose or rectum. Some may be given by injection or infusion. In some cases., Patient Controlled Analgesia (PCA) may be used. With the use of PCA, you control a pump that gives you a small dose of medication every 10-15 minutes. When pain medications are given by epidural route, medication is given through a very small tube into the spinal column. Finally, pain relief may be provided by administering local anesthetics through a very small tube next to a nerve bundle, into a joint or directly into the surgical incision.

How often can pain medications be given?

Pain medications are given in one of two ways: as needed (PRN) or scheduled. When pain is expected to be mild, medications may be given as needed. You should ask for medication when you begin to feel pain.

When it is likely that pain will be frequent, constant, or severe, pain medications are given on a scheduled basis. You are then given pain medication regularly or by continuous infusion.

Always tell the doctor or nurse if you feel that your pain is not under control. You are the best judge of your own pain. Do not be afraid to ask about using larger or more frequent doses of pain medications, or trying a different pain medication.

What about other pain relief methods?

Besides pain medications, other complementary treatments may be used for pain control. If you are interested in learning more about one or more of these treatments, please ask your doctor or nurse.

• Massage
• Heat or cold at the pain site
• Physical therapy or exercise
• Breathing exercises
• Relaxation and/ or Imagery
• Music therapy
• Distraction therapy
• Biofeedback techniques
• Transcutaneous Electronic Nerve Stimulators (TENS units)

Frequently Asked Questions

Q. Should I take pain medication only when I have a lot of pain?
A. No. Don't wait until pain becomes severe to take pain medication. Pain is easier to control when it is mild. You should take your pain medication regularly, just as prescribed. Sometimes this means you will take medicine on a regular schedule, and perhaps around-the-clock.

Q. Will I become "hooked" on or "addicted" to narcotic pain medications?
A. Addiction to pain medication is very rare. Remember, in order to take care of your pain, it is important to take pain medication regularly.

Q. If I take too much medicine, will it stop working?
A. Pain medicine does not stop working. Sometimes the body gets used to a certain medication. This is called tolerance. Changing the dose or the medication itself often solves the problem.

Q. If I complain too much, will I be treated like a difficult patient?
A. Controlling your pain is a very important part of your care. You deserve to have as little pain as possible. Ongoing pain can slow your recovery. It is very important for your health care team to know if you are in pain or are having side effects for your pain medications.

Q. What about pain control at home?
A. We will talk about a plan to take care of your pain before you leave the hospital. After you're home, if you wish to speak to your doctor or nurse about pain, call the phone number listed in the discharge instructions. These will be given to you before you leave the hospital.

See related Patient Textbooks about Anesthesiology.

See related Patient Topics About Your Medicines, Anesthesiology, Brain and Nervous System, Pain, Procedures and Therapies or Symptoms and Manifestations.

See related Provider Textbooks about Anesthesiology.

See related Provider Topics About Your Medicines, Anesthesiology, Brain and Nervous System, Pain, Procedures and Therapies or Symptoms and Manifestations.

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