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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.


Understanding pain

  • 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 medications

  • 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
There are myths and misconceptions around using opiates like morphine, which can cause people to worry. Speak with the PCSE team if you would like to talk about

  • addiction
  • 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

Tell us if you feel that the pain is not being controlled or could be better controlled to increase quality of life.