Transcript Pain: Is It All In Your Head?

Pain: Is It All In Your Head?
International Myeloma Foundation
Patient and Family Seminar
May 14, 2005
Maureen A. Carling RN
SCM, NDN, HV, FET (England)
© 2000 Maureen A. Carling All Rights Reserved
The Tragedy of Needless
Pain.
 Despite
the fact that most pain can be
managed effectively, the undertreatment, inappropriate treatment, and
in some cases, failure to treat at all, is
common.
 Do
not accept poor pain
management
Pain and Invalidation
 “Its
all in your head.”
 “You’ll
just have to learn to live with
the pain.”
 “You
have a low threshold for pain.”
Pain and Invalidation
 If
you hurt, then you DO have pain.
 Do
not allow others to invalidate
you.
The Therapeutic Window
Titration and the Therapeutic
Window
Aim of titration is to obtain and maintain level
which lies inside the therapeutic window.
When level rises above upper parameter, you
will begin to feel ‘hung-over.’
When level falls below lower parameter, you
will experience ‘breakthrough pain.’
Titration and the Therapeutic
Window

Statistically, if the pain breaks through, it takes
25%-30% of the SAME drug in immediate
release form, to raise the level back inside the
window.

If the pain breaks through 2-3 times per day or
more, it suggests that the level of the long
acting drug is at the lower margin of the
window.
“Rule of Thumb”

If the pain breaks through 2-3 times per day
or more, it is an indication that the level is
in the lower margin of the window and the
12 hour dosage needs to be increased by
50%, with a corresponding increase in the
breakthrough dosage to represent 1/3 of the
NEW dosage.
“Rule of Thumb”

Conversely, if your pain comes down,
 eg after radiation therapy, then the medications
will need to be reduced. If you wake up feeling
‘hung-over,’ especially if there has been no
breakthrough pain the previous day or so, then this
is an indication that your pain has come down..
 The 12 hour dosage is reduced by 1/3 with a
corresponding decrease in the breakthrough
medication to represent 1/3of the NEW dosage.
Rule of Thumb

Do not take breakthrough medication routinely
every four hours to prevent pain. The long acting
drug is for that.

Keep your medication regimen simple. Take your
medication with your breakfast and supper and
then you are free for the day, to get on with your
life. Just take your ‘rescue’ dose with you in case
you need it.
Side effects

Remember, there are side effects to pain as
well as side effects of medication.
Side effects

Constipation in EVERYONE taking opioids.

You need a ‘pusher’ eg Senokot and a stool
softener from the first dose of an opioid. Opioids
slow the bowel down. Your ‘pusher’ speeds it up
again. It puts the ‘push’ back that the opioid has
taken out.

Take it EVERY day.
Side Effects

Nausea and vomiting. If this occurs, it is usually
for the first 48 hours after starting on an opioid for
the first time. Taking an anti-emetic with the
opioid for the first couple of days can prevent this.

The commonest cause of nausea and vomiting
after this time, is poor bowel management.
Prevent it happening in the first place by taking
your ‘pusher’ and softener regularly
Calling for Help
Call your doctor or nurses:

If the medication you are taking is not
controlling your pain.

If you have breakthrough pain 2-3 times
daily or more.
Calling for Help

If you wake up feeling ‘hung-over’ and
especially, if you have had no breakthrough
pain the previous day or so.

If you have not had your bowels moved for
three days or more.
Calling for Help

If you have nausea and /or vomiting

If you develop new pains.
New Approaches for
Controlling Neuropathic Pain

Neuropathic pain can be controlled using
antidepressants and/or anticonvulsants, which
need to be titrated up slowly over several weeks.

These are now available in topical form along with
other drugs such as Guaifenesin, Clonidine,
Ketamine, NSAIDs and other drugs.
New Approaches to
Controlling Neuropathic Pain

Advantages:
 Reduce side effects considerably.

Relief is faster on considerably lower
dosages.

A Compounding Pharmacist would help you
with this.

Pain CAN and SHOULD be controlled

You have nothing to fear, but fear itself