5. Pain


Pain is "Normal"

Pain Needs to Be Controlled


Pain is Normal


Pain is the way our body tells us that something is wrong or may be harming us. Most people who are in the hospital have something wrong so they naturally feel pain. When we are can't sleep, or we are nervous or scared, smaller pains often feel larger. For all these reasons it is almost "normal" to feel pain when we are in a hospital.


Pain Needs to Be Controlled


When our pain is not controlled, the doctors and nurses need to know so they can make changes in the pain medicine. We do not have to “grin and bear it.” Pain makes sleep difficult, makes it hard to get out of bed and makes it so that we don’t breathe deeply. If we aren’t sleeping, we can become confused. If we don’t get out of bed, we can get blood clots. If we don’t breathe deeply, you can get pneumonia. Treating pain is very important.


Nurses often ask patients if they have pain, and if they have pain to rate the pain that they have. It is the goal of most hospitals to get a patient’s pain to a tolerable level (usually less than 3 on a ten point scale where 10 is the worst). Although it is sometimes impossible to completely get rid of pain----and trying to do so can be dangerous because too much pain medicine can make it so a patient does not breathe---we need to tell the doctor or nurse about our pain.


There are many pain medicines and ways to take pain medicines: by mouth, on the skin, in the vein, in the muscle, and even in the rectum.


There are also ways that we can help control our pain medicines.


If you are having a lot of pain, the doctors can order a PCA—or a pain controlled analgesia pump. This is a pump that contains pain medicine. By pushing a button on the machine, a patient can get pain medicine immediately. The goal of using a PCA is that the patient can get pain medicine right away and can keep getting the pain medicine until the pain goes away.


To keep a patient from overdosing on pain medicine, the PCA has several safety features. First, it can take a few minutes for pain medicine to take a full effect. Most PCAs are set up so that a patient can push the button whenever they want, but the machine will only give medicine every seven to 15 minutes—so that the last dose has had time to reach its full effect. You can usually hear a “beep” when the PCA delivers pain medicine.


Pain medicine can build up in the body. When pain medicine starts to build up in the body, people fall asleep. If more pain medicine is given, even after a patient is asleep, the patient can fall into such a deep sleep that they stop breathing. To keep this from happening, only the patient should push the pain button. If the patient is too confused or too sleepy to push the button, they should not get more pain medicine. You should not push the pain button for the patient.


If the PCA is not helping the patient’s pain, the doctors can increase the dose of the medicine that is given with each press of the pain button or the doctor can change the medicine that is in the pain pump. If the PCA is not helping enough, the patient or his/her family should tell the doctors or nurses.


Doctors can also treat pain using pills. There are many different kinds of pills that can be used to treat pain. If one kind makes you sick or doesn’t help enough, doctors can use another one. If you use pain medicines regularly, your body can be “used to” the pain medicines and you may need higher doses of the pain medicines. It is important to tell the doctors if you use pain medicines at home so that they can give you higher doses of the medicines if necessary to control your pain.


Doctors can also put pain patches on you….some of these patches, put very near to incisions, can help with pain near the incision. Others slowly release continuous levels pain medicine for up to 3 days—this helps to keep you from having episodes of pain that come and go.


It is important to get your pain treated as soon as you realize you have the pain. Once pain has been around for a while, it becomes harder to treat the pain.


Doctors can also give extra doses of pain medicines for times when they expect your pain to be worse—for example when they change the dressings on a wound from surgery or when the nurses turn you in bed. It is important to know that you can ask for extra pain medicine for these times. It is easier, and takes less medicine, to prevent pain than it does to treat it once it becomes bad.


Under certain circumstances, doctors can also put medicine in around the spinal cord to prevent pain---these are called epidurals. Epidurals are used commonly---these are what a pregnant woman has to prevent pain during childbirth. Epidurals are used after surgeries or after traumas when doctors know exactly where they expect you to have pain (for example, in your abdomen after a surgery or in your ribs after a trauma). To place an epidural, doctors put a needle into your back and insert a small catheter. They leave the catheter in place and then put pain medicine into the catheter. This can make you feel numb and can make it difficult to walk, depending on where the catheter is put.