Controlling Chronic 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?

Chronic 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. Chronic pain ranges from mild to severe. It may be constant or recurring. It is defined by how long it lasts.

Importance of pain control

Taking care of chronic pain is very important. We want you to be as comfortable as possible. This will help you eat well, sleep well, and be involved with your family and everyday activities.

Measuring your pain

You are the best judge of your own pain. Your physicians and nurses need your help to find out about your pain. This will help them provide the best treatment.

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.
• What makes your pain worse? What makes it better?
  Do certain activities increase your pain? Do certain positions make your pain worse? How well does your pain medication work? Let us know if any home remedies or other treatments worked well for you.
• Does your pain interfere with your daily life?
  Does pain interrupt your sleep? Does it hurt when you bathe? Are you able to work around the house or at your job without pain? Has your pain interrupted your activities with family and friends?
• Keep a pain diary
  Some people find it helpful to write about their pain in a diary or journal. This may help us understand your pain and improve your pain treatment.

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.

Treating your chronic pain with medication

Chronic pain is usually treated with pain medication. Pain medications are given either as needed or scheduled. Usually, if you only have pain part of the day, you will take your medications as you need them. If you have pain most of the day, you will take medications on a regular schedule.

Selecting the right pain medication

The most common types of medications used to treat chronic pain are.

• Narcotic or opioid analgesics--an example is morphine.
• Acetaminophen--commonly known by its brand name, Tylenol.
• Non-steroidal anti-inflammatory agents (NSAIDs)--some brand names are Advil, A/eve, and Motrin.
• Antidepressants--an example is amitriptyline.
• Atypical pain medicines--an example is gabapentin.

Taking pain medication

Some medications are classified as immediate-release medications. These are fast acting and last for a few hours. Slow-release medications deliver a steady amount of medication over a longer period, usually 8 to 12 hours. These medicines are taken regularly, even if you are not having pain at that moment. This may work best to manage your chronic pain. It is common for people to take both types of medications.

Sometimes certain activities make your pain worse. Taking a fast-acting pain medication before starting the activity will help. Often, a combination of pain medications (such as morphine and amitriptyline) may be used to treat certain types of pain.

How are pain medications given?

Pain medications may be given in several ways. The most convenient and least expensive way to take pain medicine is by mouth in pill form. Other ways to take medicine include:

• Liquid medication (either by mouth or through a feeding tube).
• Suppository (given rectally).
• Injection (into a muscle, into a vein, into the spinal column, or under the skin).
• Infusion (into a vein, into the spinal column, or under the skin).
• Patch (allows medication to be absorbed through the skin).

What about side effects? What can I do about them?

• Nausea - When starting pain medication, some patients may feel nauseated for two or three days. This will pass as your body adjusts. Taking your medication with food may help. Medication may be prescribed to treat the nausea.
• Drowsiness - Pain medications may cause some drowsiness for the first couple of days. However, if you feel very sleepy or your speech is slurred, tell your doctor or nurse.
• Constipation - Some pain medications, like narcotics, cause constipation. Stool softeners and laxatives will help. Take them on a regular basis.

Will the medicine stop working after I have taken it for a while?

Pain medication does not stop working. Sometimes the body gets used to a certain medication. This is called tolerance. Changing the dose or the medication often helps. If you need to take pain medicines for a long time, it may be necessary to increase the dose or change to another medicine at some point to get the same amount of pain relief.

Will become addicted to the medicine?

Some people who take pain medication worry about becoming addicted. When you have chronic pain, your body needs the medicine to live your life more comfortably. This is quite different than taking illegal drugs to "get high."

What about other pain relief methods?

Sometimes chronic pain is not completely helped by medications alone. Other methods that might work for you include:

• 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)
• Hypnosis
• Special procedures involving certain types of anesthesia
• Radiation therapy
• Surgery

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.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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