Consumer Information

Pain Management And Opioids

GENERAL INFORMATION:

What is pain? Pain is your body's way of reacting to injury or illness. Everyone reacts to pain in different ways. You are the only person who knows what your pain feels like. What you think is painful may not be painful to someone else.

What causes pain? There are many reasons why you may have pain. Following are some causes of pain:

Injuries, surgery, or diseases such as cancer.
Pressure on a nerve.
Nerves cut in an accident or surgery.

Sometimes a reason for pain cannot be found. Not finding a reason for pain does not mean you are not having pain, or that the pain does not exist.

What is your pain like? Caregivers want you to tell them about your pain. Talking about where and when you hurt helps your caregiver find the cause your pain. Caregivers also want to learn what your pain feels like. Information about your pain will help them decide on the best way to treat it. You can use the following method to help you know more about your pain:

Keep a pain diary. A pain diary will help you remember exactly what happened each day because it is all written down. A diary also helps track pain cycles. This will help you be more aware of when your pain is bad and how to make it better. A pain diary answers caregivers' questions about your pain over time. Think about the following questions. They will help your caregiver know where your pain is and what it feels like:
- Where does it hurt? Where does it not hurt? Does the pain move from one area to another?
- How does the pain feel? Try to choose words that tell your caregiver what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, crushing? Or is the pain stabbing, burning, dull, numb, or a "pins and needles" feeling?
- When did the pain start? Did it begin quickly or slowly? Is the pain steady or does it come and go?
- How often does the pain bother you? How long does it last?
- Does the pain affect your daily life? Can you go to work? Can you do your usual activities? Which activities are you unable to do?
- Does the pain wake you up from sleep? Can you go to sleep without any pain medicine?
- Do certain things or activities cause the pain to start or get worse?
- Does anything decrease the pain like changing positions, resting, medicines, or changing your exercise schedule?

Your caregiver may want you take a pain test:

Pain tests. Pain tests do not hurt you. They are paper, or paper and pencil, tests that are used to find out where your pain is and how bad it is. Here is an example of a pain test:
- How would you rate your pain on a scale from zero to ten? You will be given a piece of paper with numbers from zero to ten, or with faces on it. Your caregiver will ask you to point to the number or the face that is most like the pain you feel. No pain at all is equal to zero on a pain scale. A little discomfort, but not enough to keep you from doing your daily activities, may be one or two on a pain scale. Five may be pain that keeps you from doing about half of your daily activities. Seven or eight on a pain scale keeps you from doing most of your daily activities. At nine the pain may be so strong it is all you can think about. Ten is the worst pain you can imagine.
- Another paper test may have an outline of a body on paper or a card. You will be asked to draw a circle around the area that hurts, or draw arrows pointing to painful areas.

Pain tests can be very helpful to caregivers if you are able to point out painful areas on your body. Pain tests may be harder for you to use if there are more than one or two areas that hurt. You may want to give up, but just do your best to tell them about your pain.

Why is pain control important?

Pain affects your entire body. Your body will work hard to keep you feeling normal. Imagine walking along on a flat surface, then walking uphill. As you go up the hill, at first you want to keep the same pace. After awhile it gets harder to keep the pace, so you are forced to slow down. That is what your body does when you have pain.
Pain affects your appetite (ability or desire to eat), how well you sleep, your energy, and your ability to do your daily activities. Pain can also affect your mood (how you feel about things) and your relationships with your family, friends and co-workers. If caregivers can help you control your pain, you may suffer less and heal faster.

What kinds of pain control are available?

There are many ways to treat pain. Some of them are actions you can take like biofeedback and meditation. Biofeedback is a special way to control how your body reacts to things like stress or pain. Meditation is a therapy that teaches you how to focus inside yourself. The goal of meditation is to help you feel more calm and peaceful.
Some ways to treat pain, like acupuncture (AK-u-punk-sher), are done by caregivers. Acupuncture is a treatment based on a belief that our bodies have channels through which fluids flow. Caregivers will insert very thin needles just under your skin. This is believed to open the channels allowing fluids to flow better.
Sometimes combining treatments works well. You and your caregiver may agree to try different methods of pain control until you find one or more ways that work well for you.
Pain medicines are one of the methods caregivers may offer you to help treat your pain. Other types of medicines such as anti-depressants and muscle relaxers may be used with pain medicine for pain control. One kind of pain medicine is an opioid (OH-pee-oyd).

What is an opioid? Opioids may also be called narcotics. They are called opioids because they are related to opium. Opium is a natural pain-killing medicine that comes from a special kind of poppy flower. Some names of these medicines are codeine (KO-deen) and morphine (MOR-feen). A few of the opioid medicines are man-made. The man-made opioids work to control pain in the same way as natural opioids.

How do opioids work? When you have pain, your nerves report the information to special receptors (re-SEP-tors). A receptor works like a receiving station. It gets a message and passes it on. When the receptors get a message that you are having pain, they send a pain message to your brain. Your brain tells you that you are having pain. Opioids work by keeping the receptor from getting the message that you are having pain. You still have pain, but opioids keep your brain from telling you that you have it.

How long are opioids used? Opioids can be used for a short time (short-term) or a long time (long-term).

Short-term opioid use. It is important to take enough pain medicine to keep you comfortable. You will want to stay as stress-free as possible so you can heal quickly. Examples of short-term opioid use are:
- Surgery. You may be given opioids for a day or for a few days after surgery. Your caregivers want you to have enough pain control medicine so that you can rest or sleep comfortably. There are things you can do to prevent other medical problems after surgery. For these two activities you will need to take pain medicine:
  - Breathe deeply and cough if you are able. Caregivers may want you to take several deep breaths every hour or two while you are awake. It is very important to breathe as deeply after surgery as you did before surgery. If you have pain you may want to avoid breathing deeply. If you take all shallow breaths you may get pneumonia (new-MOAN-yuh). This can happen if your lungs do not inflate enough. Fluids can collect at the bottom of your lungs. These fluids may have germs that cause pneumonia.
  - Walk if you are able. Caregivers may want you to get up and walk with help. Walking can decrease your chance of getting a blood clot in your leg. A blood clot in your leg can cause you to spend more time in the hospital. Blood clots can be dangerous to your health.
- Labor and delivery of a baby. If you are a woman in labor you may be given opioids before giving birth and for a short time after your baby is born.
- Dental pain. Your dentist may give you an opioid for a few days for some kinds of tooth or mouth pain.
- Broken bones. Some broken bones cause a lot of pain. Caregivers may give you opioids for a few days after you break a bone to control your pain.

Long-term opioid use.
- Long-term use is two weeks or longer. Opioids may be used over a longer period of time for some painful diseases. Examples of painful diseases you may need opioids for are cancer, and some chronic (KRON-ik) (long-lasting) diseases. The pain from these diseases may be continuous, or it may last awhile then go away for awhile.

Usually, pain is a useful thing for human beings. It warns us that something is wrong. Pain keeps us from moving an area that needs rest. Pain from cancer, sickle cell crisis and chronic diseases or conditions serves no purpose. It does not warn you that something is wrong. You already know that. What you need to do is stop suffering from the pain.

Why does my caregiver want me to take an opioid? Your caregiver may want you to take an opioid if your pain is not controlled by using a pain medicine that is not an opioid. Your caregiver wants your pain to decrease enough so you are comfortable. Pain may increase the time it takes you to get better.

Will I get addicted to opioids if I take them? Many people are afraid that if they take an opioid they will get addicted. Addiction means that you do one or more of the following:

You have little or no control over how much of the opioid you are using.
You keep using the opioid even though you do not want or need it.
You keep using the opioid even though it harms you.
You crave the opioid.

The number of people who become addicted is extremely small. Opioids should only be taken for the time that they are needed. The amount of opioid that you take should naturally and slowly decrease as the pain goes away. Pain rarely stops suddenly. Pain usually eases over days, weeks, and even months. As your pain decreases, the amount of opioid you take will decrease, too.

Will I become dependent on opioids? If you are taking the same amount of opioids for two weeks or longer, you will become dependent on them. Dependence is not a problem as long as you need the opioid for your pain. You will need enough of the opioid so you do not run out. Dependence means that your body will become tolerant (TALL-er-ant) of opioids and you may have withdrawal (with-DRAW-ull) if you stop taking them suddenly.

What is tolerance? Tolerance means that if you take opioids over a long-term (two weeks or more) you will either:

Need more of the opioid to get the same amount of pain relief.
Need to take the opioid more often to get the same amount of pain relief .

What is withdrawal? If you stop taking opioids all at once, your body will want them. You may have one or more withdrawal signs and symptoms if you suddenly stop taking an opioid. Early signs of withdrawal are:

Watery eyes and runny nose.
Sweating.
Yawning.

Later signs and symptoms of withdrawal are:

Restlessness.
Irritability.
Loss of appetite or nausea (feeling sick to your stomach) or vomiting (throwing up).
Shaky hands. Legs that may jerk or jump.
Cold flashes and goose bumps. Bone and muscle pain.
Fast heartbeat and high blood pressure.
Trouble going to sleep or staying asleep.
Diarrhea (loose BM's).

If you find that you are having a problem stopping an opioid you may want to talk to a pain management specialist. Pain management specialists are doctors who specialize in treating pain. They will also help you to decrease your opioid medicine safely. It is possible to stop taking even very long-term opioid medicines without suffering from withdrawal.

What may happen to me while I am taking an opioid? Most of the signs and symptoms that come from taking opioids will go away with time. Following are signs and symptoms you may notice:

Nausea and vomiting. Nausea and vomiting are common early symptoms from taking opioids. You may need another medicine to help you control nausea. If you are very nauseated you may try drinking only clear liquids like water or weak tea.
Drowsiness. Drowsiness for the first few days after starting to take opioids is common. Do not drive or operate machinery as long as you are drowsy from opioids. Drowsiness often goes away after two or three days.
Dry mouth. Dry mouth can be helped by drinking plenty of liquids. Eating pineapple chunks, popsicles, shakes, yogurt or hard sugarless gum may help to keep your mouth moist. Take good care of your teeth and gums. Mouth dryness will affect your tongue, your teeth, and gums. Brush your teeth regularly and rinse your mouth often.
Difficulty urinating. Difficulty urinating, or not being able to control when you urinate or have a BM, happens to some people taking opioids. If you have trouble urinating, make sure to give yourself plenty of time to start the flow. Running water into a sink may help. Drink plenty of liquids. If you continue to have trouble urinating, tell your caregiver.
Confusion, hallucinations, or nightmares. Confusion, hallucinations (hal-oo-sin-A-shuns) (seeing, hearing, or feeling things that are not really there), or nightmares may happen while you are taking opioids. These symptoms may be very frightening for you. Tell your caregiver if you have these symptoms.
Constipation. Constipation (kun-stih-PA-shun) means having hard or dry BMs. For almost everyone taking opioids constipation is one symptom that will not go away. Opioids slow down digestion (di-JES-chun). Digestion is how your body breaks down and uses the food you eat. You will probably need to take laxatives or a stool softener on a regular basis while you are taking an opioid. Ask your caregiver which stool softener may help you. Stool softeners are available at drugstores and many grocery stores. You may also want to make changes to your diet while you are taking opioids:
- Eat more fiber (dried and raw fruits, raw vegetables, whole grain bread and cereals).
- Drink plenty of liquids like water and juices if you are not on a restricted liquid diet.

What if the opioid I am taking does not work? Talk to your caregiver if you are not getting relief from your opioid. You may also have signs and symptoms that are unpleasant to you, but may not bother other people. There are many different opioids available. The first one or more opioid medicines you try may not be the best ones for you.

How can opioids be taken? Opioid medicines may be taken in the following ways:

Intravenous (IV) into a vein.
By injection into a muscle or by injection just under your skin.
Epidural (ep-ih-DUR-ull) (in the space around your spinal cord).
In your mouth as a liquid you drink, sucked on as a pill, or as a lollypop.
Swallowed as a pill or tablet.
In a patch you put on your skin.
In a suppository (sup-POS-ih-tor-e) put into your rectum.

How long do opioids work?

If one method or medicine is not working for you, or if it worked for awhile then stopped working, call your caregiver. Opioid medicines may work for as little as two hours, or as many as 72 hours, after taking the medicine. It is important that you know about how long the opioid medicine you take should work. Your caregiver can give you some guidelines.
It is important that you have enough medicine to control your pain. Do not wait for the pain to get bad before you take more medicine. Do not take more medicine than your caregiver ordered for you without asking your caregiver.

Is there anything else I should know about taking opioids?

Make sure you understand how you are to take your medicine. Each opioid will have specific directions you must follow. Be sure to call your caregiver before taking more opioid medicine or taking it more often than the caregiver has ordered. Following are signs of an overdose:
- You are too sleepy to stay awake.
- You are too dizzy or weak to stand up.
- It is hard for you to breathe.
Keep your opioid medicine in a safe place. Opioid medicines may be dangerous to children. There is a kind of opioid medicine that looks like a lollypop. Children may see and want a lollypop, so this kind of opioid may be very dangerous if you have children in your home. Keep all medicines locked out of the reach of children.
Tell all your caregivers that you are taking an opioid. Some other medicines may make the effect from the opioid stronger. Some other medicines may make the effect weaker. Opioids can also affect the outcome of some tests.
Do not drink alcohol while you are taking opioids. The combination of alcohol (liquor, mixed drinks, beer, wine) with opioids is dangerous. It may kill you.
Tell your caregiver about all medicines you take. Give your caregiver a list of all your medicines, including over-the-counter medicines, herbal teas, and food supplements. Some of these may make your opioid stronger or weaker, or have another unexpected effect.
Get more information. Ask your caregiver for more information about the opioid you are taking.

What if I was addicted to opioids earlier in my life? If you were addicted to opioids earlier in your life you need to tell your caregiver. Your caregiver will want to know as much as you can tell him about your earlier addiction. If you are planning to have surgery, or have a painful condition, you will need a caregiver who specializes in pain management. There are two kinds of caregivers who specialize in treating people who are, or were, addicted to opioids. One is a pain management specialist, and the other is an addiction specialist. You can find more information about these specialists by contacting the following organization:

American Society of Addiction Medicine
4601 N. Park Avenue Upper Arcade, Suite 101
Chevy Chase, MD 20815
Phone: 1-301-656-3815
Web Address: http://www.asam.org

Where can I get more information about opioids? More information about opioids can be found by contacting the following organizations:

American Pain Society
4700 W. Lake Avenue
Glenview, IL 60025
Phone: 1-847-375-4715
Web Address: http://www.ampainsoc.org

American Academy of Pain Management
13947 Mono Way #A
Sonora, CA 95370
Phone: 1-209-533-9744
Web Address: www.aapainmanage.org

Call your caregiver if you have any of the following problems:

You have rashes or itching after taking your medicine.
You have new pain or the pain seems to be different.
You feel very anxious, nervous, or agitated after you take your medicine.
You feel sick to your stomach or throw up after taking your medicine.
You have trouble urinating, or controlling your bladder or BMs.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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