University College London Hospitals. Managing pain at home Information for adult patients

Transcription

1 University College London Hospitals Managing pain at home Information for adult patients

2 Table of Contents 1. Introduction to pain relief 3 2. What can be done to manage pain? 4 Drugs and medicines 4 Other ways to manage pain 7 What to do if you still have pain 10 How to stop taking your medicines 10 What to do with leftover medicines Resources and further information 11 Websites 11 Further reading list 11 Wellbeing podcasts Contact Us 12 2

3 1. Introduction to pain relief We are all likely to experience pain during our lives and particularly so when we are unwell or in hospital. Pain is a common reason for seeking medical help. It is an unpleasant experience that can cause fear and anxiety. It can be helpful to understand the complex links between body and emotions, which make the experience of pain very personal. We hope that this booklet will help explain the different ways in which pain can be managed. This includes things you can do yourself to control pain at home. Your healthcare team will aim to control your pain using drugs and other techniques. They will also want to help you keep active, as this will help you feel better and reduces serious risks like chest infections, blood clots and pressure sores. If your pain is well controlled it may enable you to get back to normal activities sooner and safely. 3

4 2. What can be done to manage pain? Drugs and medicines The medicines your doctor has prescribed come with leaflets providing detailed information about each of the drugs and their potential side effects. You can also ask your pharmacist or GP if you have any questions. Often you are prescribed several different pain medicines when you leave hospital and it can be difficult to know how and when to take them. The different drugs work in different ways, so they are often combined for maximum effect. In general it is best to take one medicine regularly and add other types of medicine if needed to help keep comfortable and to stay active. 4 We recommend that you do not wait for the pain to become severe before taking these medicines. We know that pain is easier to deal with if tackled early. Taking simple pain medicines, like paracetamol and anti-inflammatories, regularly may mean that you can avoid or reduce the doses of some of the stronger medicines, which can have unwanted side effects.

5 Side effects are usually related to the amount of the drug you are taking, but some people are more sensitive than others. Certain pain medicines are not suitable for everyone. For instance, antiinflammatories (e.g. ibuprofen, diclofenac) can lead to stomach irritation or may worsen asthma in some patients. There are 3 main groups of pain relief medicines: 1. Paracetamol Paracetamol has few side effects if taken in the correct dose and works very well for mild pain. If the pain is moderate or severe it is still proven to be useful particularly as it helps reduce the dose of other medicines. It is unlikely to make you sleepy or to upset your stomach. The maximum dose is two 500mg tablets four to six hourly; you should not take more than eight tablets in 24 hours. 2. Anti-inflammatory medicines These can be referred to as NSAIDs (non-steroidal antiinflammatory drugs); examples include ibuprofen, naproxen, diclofenac, meloxicam, indomethacin and piroxicam. You should not take more than one type of anti-inflammatory medicine at any one time. The doses vary so it is important to follow the instructions on the box or on your prescription. These medicines are effective but can have side effects, such as stomach irritation. If you notice this you should seek advice as 5

6 6 you may need to stop taking it, or ask your doctor to prescribe another medicine to help protect your stomach. Antiinflammatories should be avoided by people with stomach ulcers, kidney problems, some types of asthma, heart disease, stroke or circulation problems. 3. Opioid medicines These include dihydrocodeine, codeine phosphate, tramadol, morphine, fentanyl, oxycodone. These strong pain medicines are more likely to have side effects than paracetamol or antiinflammatory drugs. These include feeling drowsy or light headed, nausea or sickness and constipation (which can be lessened by drinking plenty of fluids, taking stool softeners and laxatives if necessary). Other medicines There are other specialist drugs which are occasionally used to manage certain types of pain. These include gabapentin, amitriptyline, clonidine, and ketamine. Taking more than one type of pain relief medicine The different groups of drugs work in different ways, so they are often combined for maximum effect. Start by taking paracetamol. If your pain is more than mild, add an anti-inflammatory.

7 You should take these regularly according to the instructions on the box or your prescription, until your pain is only mild. Once your pain is controlled you can then reduce the number you are taking each day until you are just on paracetamol again. What if your pain is not controlled with paracetamol and anti -inflammatory medicines or if you can t take antiinflammatory medicines? You may have been given an opioid-based medicine such as codeine, tramadol, morphine (oromorph, MST or sevredol), oxycodone (oxycontin or oxynorm). Take these as instructed on the label. You may need to vary the dose, for example one or two tablets, and the time between doses according to the level of your pain. You must not take more than the maximum stated on the label. You should continue to take paracetamol and antiinflammatories (if you are able) regularly. Other ways to manage pain Because thoughts and feelings can affect the way we experience pain, things that help you to relax, lift your mood and feel more confident, can lessen pain. You might find it useful to listen to music, watch a film, talk to someone about your feelings or do an activity you enjoy. Being alone with your worries generally makes pain worse. 7

8 8 Movement and gentle exercise It s natural to be hesitant if you are in pain but activity helps to stretch stiff and tense muscles, ligaments and joints, which may actually lessen pain. Distract yourself Shifting your attention onto something else so the pain isn t the only thing on your mind can really help. Talking, listening to music, reading, or watching TV may all be useful. You may not be able to push pain right out of your mind, but you can often find a way to put it in the background. Mindfulness and meditation can help with relaxation and the acceptance of pain, we have provided some links to information about these techniques in the resources at the end of this booklet. Breathe well Concentrating on your breathing when you are in pain can help. When the pain is intense it s very easy to start taking shallow,

9 rapid breaths which can make you feel dizzy, anxious or panicked. Instead, breathe slowly and deeply, you may find the following exercise helpful: Breathe in to a count of five, then breathe out with your lips pursed (as if you were blowing out a candle) to a count of ten, repeat for a few minutes. Breathing well helps you to feel more in control of the situation, stay relaxed and prevent any muscle tension or anxiety from worsening your pain. Support Talking to friends and family, other patients and staff can help you feel much better. Relax We know that practising relaxation techniques regularly can help to reduce persistent pain. There are many types of relaxation techniques, from breathing exercises to types of meditation. These are freely available on the internet (see section 3 for resources). Other therapies Complementary therapies, for example acupuncture, can be helpful in some cases. Alternative medicines are not tested as carefully as prescribed medicines, so if you try them, start cautiously. 9

10 10 What to do if you still have pain If you have reached the maximum dose of your medicines and still have severe pain, you should contact your medical team. You may have been given a number to call at the hospital. If not, contact your GP or go to your local walk-in clinic. If no other service is available, go to an emergency department. How to stop taking your medicines If you have been taking a combination of medicines, it can be confusing to know how to stop them as your pain improves or as you get better at managing it. If you are taking opioid-based medicines, reduce them at first, cutting down gradually until you no longer need them. Then reduce and stop the antiinflammatory medicines. When your pain is only intermittent or mild, you can stop taking the paracetamol regularly and just take it as needed. For many people, pain is worse at night. If this is the case for you, stop the daytime doses first and continue to take the pain relief at night until the pain has improved. What to do with leftover medicines Take any left over medicines to your local pharmacy for disposal. You should not give them to other people to take as this may not be safe.

11 3. Resources and further information Websites The British Pain Society ( Mindfulness for health Breathworks ( Reading Publications are available from The British Pain Society website ( Publications are available from the Royal College of Anaesthetists website ( pain-relief-home ) Pain Relief at Home (2012) Books Living Well with Pain and Illness: The Mindful Way to Free Yourself from Suffering, by V Burch (2011) Wellbeing podcasts Podcasts from the Mental Health Foundation ( Stress and Relaxation: Quick Fix Breathing Exercise Wellbeing and Sleep: Quick Fix Relaxation Exercise What is Mindfulness? Mindfulness - 10 Minute Practice Exercise Podcast Podcasts also available from Breathworks for Mindfulness ( 11

12 Contact details If you need help managing your pain, please either contact your GP or the team who were looking after you in hospital. Contact details of the team who were looking after you: Main hospital address: 235 Euston Road London NW1 2BU Telephone: / Website: If you would like this document in another language or format, or require the services of an interpreter, contact us on We will do our best to meet your needs. First published: May 2014 Date last reviewed: May 2014 Date next review due: May 2016 Leaflet code: UCLH/CS/MPAH-AP/1 University College London Hospitals NHS Foundation Trust 12