Pain Management

Isn't pain an inevitable part of my condition?

Not necessarily. Many patients with cancer and other life limiting conditions do experience pain, but a significant number do not. For those who do experience pain, there are a number of ways to manage that pain, and it is usually (though unfortunately not always) possible to either eliminate the pain completely or reduce it to levels which are acceptable to the patient.

What medications are available to help control my pain?

Drugs that treat pain are known as analgesics. There are different types of analgesic available, depending on the type of pain and its severity; the type that your doctor prescribes for you will be based on how bad your pain is. For relatively mild pain you may be prescribed paracetamol or ibuprofen; for moderate pain the doctor may prescribe codeine phosphate; while more severe pain is usually tackled with a stronger painkiller such as morphine.

Most painkillers are taken by mouth, as tablets, capsules or liquids, but some patients have difficulty swallowing. Options available for these patients include injections, patches, suppositories and syringe drivers, which deliver a constant ‘supply’ of medication to the patient without the need for regular injections.

In addition to the painkillers mentioned above, your doctor may prescribe one or more ‘indirect analgesics’, known as adjuvant analgesics. These could be drugs such as amitriptyline or carbamazepine, to treat neuralgia; dexamethasone or other steroids to reduce swelling; Buscopan to reduce muscle spasms; and antibiotics such as amoxycillin to treat infection.

Isn't morphine dangerous?

Many patients, and their carers, have concerns when their doctor prescribes morphine. Some concerns are:

• Will I get addicted? No. Although morphine has a reputation as a ‘recreational’ drug, it is very rare to see addiction in patients who take morphine for the relief of pain.

• Will it wear off? No. As long as your condition remains stable, the dose of morphine will not need to be increased. You will not build up ‘resistance’ to the pain relieving qualities of morphine. However, should your condition get worse, it may be necessary to increase your dose.
• Will I be ‘drugged’ or drowsy all the time? Patients can become drowsy when they first start to use morphine. However, this usually wears off within a week, and patients can carry out such normal activities as driving.
• Does morphine ‘finish you off’? No. There is no evidence that morphine shortens life when it is used correctly. It is as safe as, or safer than, many of the drugs available at your chemists.
• Aren't there bad side effects? As with many drugs, morphine have can have side-effects. These can include nausea or vomiting, vivid dreams, dry mouth and constipation. Some people get an itchy rash, but this is rare. Constipation is the most common, and troublesome, side-effect, and you should be prescribed a regular laxative to stop it from occurring. In the unlikely event that you are unable to tolerate morphine, there are a number of alternatives widely available.

Any tips on taking my medication?

A few:

• Ask your doctor to explain what the medication is, what it is for and how to take it.

• Read the instructions and information on the package or in the leaflet before you start taking the medication.
• Always take your medication when you're supposed to. If, for example, you are told to take it three times a day, do so three times a day at the correct times. Don't wait until you’re in pain to take regular medication. If you are prescribed medication for ‘breakthrough’ pain, or ‘flare-ups’, take it when the pain begins and don’t wait until the pain becomes unbearable.
• If you’re taking tablets, take them with water, not hot or fizzy drinks. Swallow the tablets whole and never crush or chew them, unless your doctor tells you otherwise.
• Make sure you eat regularly; this means there is less chance of your feeling sick.
• If you get side-effects and they are causing you concern, speak to your doctor, nurse or pharmacist.
• Always keep your medication in a safe place.

Are there any other things that can be done to ease my pain?

Yes, there are a number of things. Some people find that heat and/or cold helps, so you might like to try a hot water bottle, heat pad or ice pack. Some people find that gentle massage of the affected area helps; perhaps a relative or friend could do this for you?

There are various relaxation and visualisation techniques which can be helpful, as can breathing exercises and physical exercise itself if you are up to it. Try to make sure you get enough sleep, and if there are any issues which are worrying you or causing you stress, find someone to whom you can talk about these issues, whether a relative, friend, or someone recommended by your doctor or nurse.