Controlling pain can help you live a fuller life.

When pain is managed, people can enjoy activities, do household tasks, enjoy company and sleep. Uncontrolled pain may cause anxiety or depression.

Studies show people respond better to treatment and have more active immune systems when pain is controlled. They recover faster from surgery and are less likely to have nerve changes that extend pain after the original problem heals.

Today, there are excellent treatments for pain. Most people find relief in medicines taken by mouth. People who can’t swallow or don’t get adequate relief with oral medications or those taken under the tongue may use a skin patch, suppository or injection. People with pain that’s harder to control may need to add other medications, use radiation therapy (for cancer), nerve blocks or surgery.

The most effective strategies for pain control may combine several medications, therapies, and mind-body techniques.

Non-medicinal treatments can be helpful, like relaxation exercises, listening to music, distraction with pleasant activities, massage, imagery, hot or cold packs, rest, counseling and support groups.

Getting Pain Relief

You have a right to pain relief. Ask your hospice team how they plan to treat pain. When you’re in pain, tell your team. Give them details to help in providing the best treatment.

Serious pain is a medical emergency.

Pain Medication

Many medicines control pain, and you may require a combination of two or more. If you have constant pain, take your medicine on a regular schedule and don’t wait for pain to begin. You might also have “flare-up” or “break-through” pain. It’s good to have a fast-acting medicine on hand to add when needed.

For Mild to Moderate Pain

Non-prescription pain relievers include aspirin, acetaminophen, ibuprofen (Motrin) and naproxen (Aleve). Each of these may have serious side effects. Do not start these without asking your doctor if they can be taken with your other medicines and about other precautions.

For Moderate to Severe Pain

Opioids require a prescription, including morphine, hydrocodone, oxycodone, codeine, fentanyl, methadone and hydromorphone. Opioids can be combined with other medicines and do not cause stomach bleeding or organ damage. They do cause constipation, so you should take a laxative with them. They may also cause nausea, sleepiness or itching. Opioids may cause slow breathing if the dose is excessive, but this is extremely rare in people who take them on a regular basis for pain.

Combining Other Medicines

Some drugs work best if they are combined with other types of medications, called adjuvants. These help slow pain signals and might include:

• Antidepressants like amitriptyline, desipramine, nortriptyline and duloxetine can help control tingling or burning pain. They also can help improve sleep. Some antidepressants can cause dry mouth, drowsiness or constipation. Some can cause dizziness.
• Anticonvulsants include gabapentin, valproic acid and carbamazepine. In addition to treating seizures, these also help ease nerve pain, especially if it feels like tingling, stabbing or electrical shocks. Some of these can cause nausea or dizziness. Some also require blood tests to monitor possible side effects.
• Steroids include prednisone and dexamethasone. They help with cancer pain and bone pain, plus pain caused by inflammation, pressure on nerves, or a tumor pressing on the brain or spinal cord. Steroids can increase appetite, fluid retention, stomach irritation or confusion.
• Anti-inflammatories include ibuprofen, naproxen and meloxicam. They can be added to the stronger pain medicines for people who have bone pain or pain from inflammation. These can cause kidney problems or stomach irritation and bleeding.

Side Effects

Pain medication can have side effects that can appear in the first few hours or days of beginning treatment. These side effects usually lessen over time. Each person is different and not every person will have side effects.

Watch for and let your team know about side effects. They will make adjustments as needed.

Constipation

Unfortunately, this is a side effect of opioid medicines that does not usually go away with time. Taking proper steps can make a difference.

Most people will need to do two things. Start a laxative at the same time you start taking an opioid medicine, especially if constipation has been a common problem. If possible, increase your fluids, eat more fruits and vegetables, and stay as active as possible.

When someone is very ill and dying, it is natural to eat less and move less. Constipation still can be controlled with the right medications.

Nausea and Vomiting

Some people taking pain medicines will have nausea and vomiting, which is more common the first three days. Have an anti-nausea medicine on hand when you start the pain medication. If nausea develops, you can take the anti-nausea medicine on a regular schedule for several days. It may not be needed after that.

Sleepiness or Confusion

Like other side effects, this problem happens during the first few days of treatment or after a dose increase, and then wears off in most people. If it remains a problem, you can ask about a medicine that helps keep you more alert, your doctor can adjust your pain medicine or you can change to a different pain medicine. Sometimes people sleep a great deal in the first few days after starting a pain medication because their unrelieved pain was causing exhaustion. Pain relief allows them to finally relax and sleep deeply.

Slowed Breathing

This side effect usually is not a problem if your pain medicine is given at recommended doses and if an increased dose is necessary, it is gradually increased. If you are still experiencing pain, the increased medication will not slow your breathing significantly. Your doctor or nurse can tell you how to determine whether an increase is appropriate.

Frequently Asked Questions

Q: Should I take pain medicine only when I’m in pain?

Pain control is much easier if you take medicine before the pain becomes intense. The goal is to prevent pain or to keep it at a mild level, and to reach this goal, many hospice patients take the medicine on a schedule.

Q: If I take the stronger drugs now, will they work later on when I really need them?

Yes. Sometimes your body gets used to a drug and you will need to take more to control pain. Your doctor will adjust your dosage as needed.

Q: Will I get “hooked” or addicted to pain medicine?

Addiction is dependence on a drug for mental reasons such as “getting high.” People who take medications to relieve pain rarely have problems with addiction. They take only the medications they need to control pain. Uncontrolled pain can have negative long-lasting effects, so your doctor will strongly encourage you to take pain medicine if you need it. If you must stop the medicine for any reason, your doctor will slowly reduce the dose over a few days to allow your body to adjust. Do not stop medications abruptly without consulting your doctor.

Q: Are morphine and other strong pain relievers used only for the last stages of life?

No. Anyone who has moderate or severe pain should take medicine that is strong enough to relieve that pain, even if the pain is temporary. For example, some people recovering from common surgery receive morphine for post-surgical pain control.

Q: If I ask for pain medicine, will I be viewed as a “bad” patient?

Helping you to enjoy a good quality of life is an important goal of medicine. Pain is a normal part of many conditions and your physician does not want you to suffer if relief can be provided. A “good” patient is one who provides a highly accurate picture of the problem to the doctor. So don’t withhold the information that your doctor needs to provide you with the best treatment.

Questions you should expect

• Where is your pain? Do you hurt in more than one part of your body?
• What type of pain is it? Is it sharp, stabbing, burning, tingling, numbing, aching, throbbing? You might find other words to describe it.
• How bad is the pain? Is it mild, moderate, or severe? Where does the pain fall on a scale of zero to 10, with zero being no pain and 10 being the worst pain imaginable?
• What makes the pain better or worse? Is it better or worse with certain activities, eating or being in a certain position?
• What medicines have helped it? What medicines have you tried that did not help or did not agree with you?
• Is the pain present all the time or does it come and go? When did it start?
• Has the pain changed over time?
• Is your current pain medicine controlling the pain? Are you having problems with side effects?
• How does the pain affect your mood, activities or ability to interact with others?
• What is your goal for pain relief? What level of pain control do you want to achieve?

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