2.1 Managing pain
One of the greatest fears of people and their carers is severe and uncontrolled pain.
Many people with a life-threatening illness fear severe and uncontrolled pain but not everyone experiences this.
- Pain is individual. The treatment approach depends on how a person describes their pain
- Pain can almost always be managed, but is managed best when identified early. Be honest about the extent and nature of pain – being honest does not mean a person is not coping
- Untreated pain can cause or increase tiredness, low mood, worry, anger, poor appetite and stress
- Pain treatments include medication but also heat/cold packs, massage, relaxation and spiritual or psychological (such as music and art therapy)
- Pain relief medications include paracetamol/aspirin, codeine, morphine or other opiates, such as hydromorphone, oxycodone or fentanyl patches
- Morphine is the most commonly used opiate for moderate to severe pain
- delaying morphine
- concern about hastening death
What are the side effects of opiates (morphine & similar drugs)?
- Constipation, which can be controlled with laxatives (See Bowel Care on page 37)
- Short-term nausea, sleepiness or confusion, which usually settle down
- If there are continuing, unacceptable side effects, other medications can be discussed
Types of doses
Long-term dose: The doctor may prescribe a regular dose of pain medication that acts over a long period of time, e.g. 12 or 24 hours.
Breakthrough pain: When pain is experienced between doses, you might need a ‘breakthrough’ pain medication that acts within 30-60 minutes.
Keep a record of the amount of ‘breakthrough’ medication being used so that the PCSE team can review dosage of baseline medication.
What you can do: tips for carers
- Encourage the person you care for to take an active role in managing their pain
- Keep a pain diary, noting the description and location of pain, for the PCSE team to review and discuss options
- PCSE team do not carry pain medications with them. Staff will help you make sure you have enough medications available