Rehabilitative Pain Management

GENERAL INFORMATION:

What is rehabilitative pain management? Rehabilitative (re-huh-bill-ih-TA-tiv) pain management is treatments and therapies to decrease pain while recovering from an injury or illness. It may also be used to learn how to do activities differently to avoid re-injury or a new injury. Usually a team of caregivers works together in this process. Pain is your body's way of reacting to your injury or illness. Everybody reacts to pain in different ways. What you think is painful may not be painful to someone else. But, pain is whatever you say it is!

What causes this kind of injury and pain? Pain can be caused by many things, such as an injury, surgery, or a disease. A nerve being stretched, pinched, or pressed by twisting your back or lifting something heavy can cause pain. Other pain is caused by overuse like a pitcher who throws a ball all the time. After an injury or surgery you may not want to move the painful part of your body at all. But, you may have pain because you are not moving this body part. Sometimes there is no clear reason for your pain.

What are the different types of pain? Pain may be acute or chronic.

• Acute pain is short-lived and usually lasts less than 3 months. Caregivers help first work to remove the cause of the pain, such as fixing a broken arm. Acute pain can usually be controlled or stopped with pain medicine.
  
  
• Chronic pain lasts longer than 3 to 6 months. This kind of pain is often more complex. Caregivers may use medicines along with other treatments, like braces, splints, self-hypnosis and relaxation therapies to help your pain.

What is your pain like? Caregivers want you to talk to them about your pain. This helps them learn what may be causing the pain and how best to treat it. Tell caregivers your answers to the following questions.

• Where does it hurt? Where does it not hurt? Does the pain move from one area to another?
  
  
• How would you rate the pain on a scale of 0 to 10? (0 is no pain, and 10 is the worst pain you ever had.)
  
  
• How does the pain feel? Try to choose words that tell caregivers what type of pain you have. Is the pain sharp, cramping, twisting, squeezing, or crushing? Or, is the pain stabbing, burning, dull, numb, or "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 and how long does it last?
  
  
• Does the pain affect your daily life? Can you still work in spite of the pain?
  
  
• Does the pain wake you from sleep?
  
  
• Do certain things or activities cause the pain to start or get worse like running or lifting heavy boxes?
  
  
• Does anything decrease the pain like changing positions, resting, medicines, or changing your exercise schedule?

Why is pain control important? Pain can affect your appetite (ability or desire to eat), how well you sleep, your energy and your ability to do things. Pain can also affect your mood (how you feel about things) and relationships with others. If caregivers can help you control your pain, you will suffer less and can even heal faster.

Care: The best way to decrease pain is to treat the cause of the pain. Almost all types of pain can be controlled with medicine and other treatments. It may be hard to get your pain to go away completely. But, it is possible to lower your pain level so you can live and be comfortable doing everyday things. You and your caregiver will work together to find what pain control treatments are best for you. Always tell your caregiver if the pain gets worse. Ask your caregiver if you want more information on any of the following pain control treatments.

• Muscle Relaxers: You may need medicine to help your muscles relax. This medicine can be given by IV, as a shot, or by mouth. Muscle relaxers can make you feel dizzy or weak. Call you caregiver if you need help getting out of bed.
  
  
• NSAIDS (N-said): This medicine may be given to decrease inflammation (in-fluh-MA-shun) which is redness, pain, and swelling. It is usually given by mouth.
  
  
• Pain medicine affects the nervous system so you feel less pain. Your caregiver will tell you how much to take and how often. Take the medicine regularly as directed by your caregiver. Do not wait until the pain is too bad. The medicine may not work as well at controlling the pain if you wait too long to take it. Tell caregivers if the pain does not go away or comes back.
  
  
• Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.

How can pain medicine be given? Following are the many different ways pain medicine can be given depending on the kind of pain you have.

• By mouth: You may be given pills or liquid to swallow or you may be given a pill or liquid to put under your tongue. Pain medicine may also be given as a lozenge (law-zenj) that you suck on like a cough drop.
  
  
• Epidural (eh-pih-DER-ull): Medicine is given through a catheter (tube ) that caregivers put into epidural space (the areas around the spinal cord).
  
  
• Intranasal: Medicine is dripped or sprayed into the nose.
  
  
• Nerve block: A shot of medicine is put close to the nerves in the area that hurts to break the pain cycle. The medicine makes the nerves unable to send pain messages to your brain. Nerve blocks give short-term relief of pain so that you can use the painful part and have a more normal life.
  
  
• PCA: A PCA device to give you pain medicine. PCA stands for patient-controlled analgesia (an-ull-G-z-uh). This is an electric pump with pain medicine which is connected through a tube to an IV (in your vein) or sub-q (under your skin). You press a button when you feel pain and you receive medicine from the pump through the tube. Caregivers have set the pump so you cannot get too much medicine. A PCA pump works well to control pain because you can give yourself medicine before the pain gets too bad. Being in control of your pain relief also helps you relax and deal with the pain better.
  
  
• Rectal: Medicine in a suppository (suh-PAW-zih-tor-e) is put into your rectum.
  
  
• Shot: Pain medicine can be given as a shot in an IV, into a muscle, or under the skin (sub-q).
  
  
• Topical: Medicine in a cream or gel is spread over your skin.
  
  
• Transdermal: Some medicine can be given as a patch put on the skin. This medicine is released slowly to give pain relief for as long as 72 hours

How can you take pain medicine safely and make it work the best for you?

• It is always best to take your pain medicines 30 minutes before you do exercises or physical therapy. Ask you caregivers to help you schedule your medicines so that you will be in good pain control. Good pain control will allow you to better meet the goals of your rehabilitative treatments.
  
  
• Some pain medicines can make you breathe less deeply and less often. The medicine may also make you sleepy, dizzy, and unsafe to drive a car or use heavy equipment. For these reasons, it is very important to follow your caregivers advice on how to use this medicine.
  
  
• Sometimes the pain is worse when you first wake up in the morning. This may happen if you did not have enough pain medicine in your blood stream to last through the night. Caregivers may tell you to take a dose of pain medicine during the night.
  
  
• Some foods, alcohol, and other medicines may cause unpleasant side effects when you take pain medicine. Follow your caregiver's advice about how to prevent these problems.
  
  
• Pain medicine can make you constipated (hard BMs). Following are some things that you can do to deal with constipation.
  
  
  • Eat more foods high in fiber. Some high-fiber foods are raw fruits and vegetables, whole-grain breads and cereals, dried fruits, popcorn, and nuts.
    
    
  • Avoid hard cheeses and refined grains, such as rice and macaroni.
    
    
  • Talk to your caregiver about drinking more liquids if you are not on a fluid restriction. Drinking warm or hot liquids can help make your bowels more active. Prune juice may also help make the BM softer.
    
    
  • Caregivers may tell you to take fiber medicine to help make your BMs softer and more regular. This fiber medicine can be bought at any grocery or drug store. Also, ask your caregiver about taking a mild laxative (medicine to soften BMs).
    
    
  • Get more exercise if possible.
  
  
• Do not stop taking narcotic pain medicine suddenly if you have been taking it longer than 2 weeks. Your body may have become used to the medicine. Stopping the medicine all at once may cause unpleasant or dangerous side effects.
  
  
• With time, you may feel that the pain medicine is not working as well as it did before. Call your caregiver if this happens. Together you can find new ways to control the pain.

• Acupuncture (AH-q-punk-sher) is based on the belief that life forces move through the body in specific paths. These paths are called meridians (mer-ih-d-uns). With acupuncture, a needle is put into the meridian that runs to the area where you have pain. This needle blocks the meridian which stops or decreases the pain.
  
  
• Arch supports and orthotics (or-THAH-tiks) are special devices that are put in your shoes to help you stand, walk, or run correctly. Often people develop chronic pain in their calves, thighs and hips from bad standing posture.
  
  
• Biofeedback teaches your body to respond in a different way to the stress of being in pain. Teaching your body to relax helps make the pain less. Caregivers may use a biofeedback machine so that you know right away when your body is relaxed. But often you may not need any machines. Learn to take your pulse. Then take it while making you mind think about "slowing down" your pulse. This can work with breathing, temperature and blood pressure too!!
  
  
• Heat and cold can help decrease pain. Some types of pain improve best using heat while other types of pain improve most with cold. Caregivers will tell you if hot and/or cold packs will help your pain. Also, remember that a long warm bath may help calm you and let your muscles relax. A cool shower on a very hot summer day may do the same thing.
  
  
• Hydrotherapy (hi-dro-THER-rah-p) is a gentle water exercise program. It can strengthen muscles that are not damaged, decrease pain and inflammation (swelling). Your physical therapist or caregiver may encourage you to start a hydrotherapy program.
  
  
• Knee sleeves and braces are thought to decrease pain by giving your knees extra support. They should always be used along with exercises to help make your knees stronger. Caregivers will help you learn how to use them correctly.
  
  
• Massage is often used to help a person become more relaxed. Have someone gently massage your back, shoulders, and neck. Massage can be even more effective if you also use guided imagery, breathing exercises, or music.
  
  
• Physical therapy can be helpful with pain that was caused by not moving one part of your body. Stretching the muscles and doing special exercises will make them stronger around the injured area. Over time, this can help the pain go away.
  
  
• Rest is when you stop doing the activities that cause pain. Caregivers may have you do activities that use the same muscles but do not cause re-injury or new injury. For example, a runner with leg injuries may be told to swim or bike while his leg is healing. Different exercises will decrease stress and pain on injured leg muscles. But, the runner will still stay in shape.
  
  
• Relaxation teaches your body to respond in a different way to the stress of being in pain. Normally, when pain starts, your body reacts by tensing muscles, faster heartbeat, and higher blood pressure. Your breathing also gets faster and more shallow. These reactions can make the pain worse. Relaxation helps make the pain less by changing these responses.
  
  
• Self-hypnosis is a way to change your level of awareness. This means that by focusing your attention you can move away from your pain. You make yourself open to suggestions like ignoring the pain or seeing the pain in a positive way. It is not known exactly how hypnosis helps pain. But, hypnosis can give long-lasting relief of pain without affecting your normal activities. Self-hypnosis gives you better control of your body. You may feel less hopeless and helpless because you are doing something to decrease the pain.
  
  
• Spinal cord stimulation is a nerve stimulation technique that is similar to TENS. The difference is that in SCS an electrode (a metal wire) is put near the spinal cord during surgery. SCS also uses mild, safe electrical signals to help control pain.
  
  
• Splints, canes, crutchesand walkers are all devices that caregivers use help you move, to decrease pain, and assist in your healing process. They help you to remove pressure from the injury and provide extra support.
  
  
• Surgery may be done to stop pain. Caregivers may do surgery to cut the nerves to the painful area. The goal of this surgery is to stop the pain without losing feeling or movement in the area. In some people the pain can come back after surgery or the pain may even be worse. For these reasons, surgery is usually not considered until all other pain control treatments have been tried.
  
  
• Taping is sometimes used to give special support to weak muscles and keep parts of your body in the correct position. Taping should only be done for short times and by experienced caregivers.
  
  
• TENS is short for transcutaneous (trans-q-TAIN-e-us) electrical nerve stimulation (stih-mew-LA-shun). A TENS unit is a portable, pocket-sized, battery-powered device which attaches to the skin. The TENS unit uses mild, safe electrical signals to help control pain.
  
  
• Ultrasound uses sound wave energy to help muscles relax and decrease pain. Phonophoresis (fo-no-fo-REH-siss) is a treatment that uses ultrasound waves to massage in topical medicines to help pain and decrease inflammation (swelling).

• American Chronic Pain Association
  P.O. Box 850
  Rocklin, CA 95677
  Web Address: http://www.theacpa.org
  

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

• American Physical Therapy Association
  1111 North Fairfax Street
  Alexandria, VA 22314
  Phone: 1-800-999-2782
  Web Address: http://www.apta.org
  

• National Chronic Pain Outreach Association
  PO Box 274
  Millboro, VA 24460
  Phone: 1-540-862-9437
  Web Address: www.chronicpain.org
  

• The medicine you are taking makes you sleepier than usual or confused.
  
  
• You have a new pain or the pain seems different than before.
  
  
• You have constipation that is not decreased with the treatments described above.

CARE AGREEMENT:

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

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