Prime Health Solutions

General Pain is often refered to as acute pain. Acute pain is currently defined as pain lasting less than 3 to 6 months, or pain that is directly related to tissue damage. This is the kind of pain that is experienced from a paper cut or needle prick. Other examples of acute pain include:

• Touching a hot stove or iron. This pain will cause a fast, immediate, intense pain with an almost simultaneous withdrawal of the body part that is being burned. More of an aching pain might be experience a few seconds after the initial pain and withdrawal.
• Smashing one's finger with a hammer. This pain is similar to that of touching a hot stove in that there is immediate pain, withdrawal and then "slower" aching pain.
• Labor pains. The pain during childbirth is acute and the cause is certainly identifiable.

The longer pain goes on the more susceptible it is to other influences and developing into a chronic pain problem. These influences include such things as the ongoing pain signal input to the nervous system even without tissue damage, lack of exercise (physical deconditioning), a person’s thoughts about the pain, as well as emotional states such as depression and anxiety.

Main Causes of Acute Pain

Acute pain that often needs treatment includes:

• pain after surgery
• pain from injuries or burns
• pain from problems such as arthritis, kidney stones, gallbladder stones, heart disease and headaches
• special situations such as the pain of childbirth

How is Pain Measured?

Older children and adults are often asked to score their pain using a number scale between 0 and 10. No pain is scored as 0 and the worst pain you could ever imagine is 10. You tell the nurse or doctor what your pain is on that scale between 0 and 10. There is no right or wrong answer. Everyone is different.

Sometimes you may be asked to choose words to rate your pain. Examples of these words are:

• no pain
• mild pain
• moderate pain
• severe pain

Another scale sometimes used with older children and adults is the Visual Analogue Scale (VAS). The VAS is a 10 cm line on a piece of paper or ruler with 0 marked at one end (this means ‘no pain’) and 10 at the other end (this means the ‘worst pain you could imagine’. You will be asked to make a mark on that line to show where you pain is.

Younger children can’t measure pain using numbers. If your child is in hospital, there are special measures that can help you and the doctors and nurses score his or her pain. One way to do this is for them to point to a face that shows how sore they are or how much hurt they have.

Scoring pain can be more difficult in babies and other patients who can’t communicate well. In these patients we can assess pain by looking at how they behave. For example, we look at crying, face expressions, and changes in breathing and heart rate.

People used to think that severe pain after surgery or injury was something they had to put up with. This is not the case. New methods of pain relief have been developed. Today, you can work with your health carers to control just about any kind of acute pain.

Pain control can help you to:

• be more comfortable while you heal
• get well faster, and perhaps leave hospital sooner

WHO IS INVOLVED?

This will depend on where you are and the type of pain you have. In hospital, a range of health care professionals will work with you to control your pain. They include doctors (for example, anaesthetists and surgeons), nurses and physiotherapists. Many hospitals now have Acute Pain Services (often called APSs), where a team will help treat your pain.

Outside the hospital, your GP will usually be the person helping you manage your pain, although other health care professionals may also be involved.

You have a very important role to play in the treatment of your pain.

How is Pain Measured?

There are a number of ways you can be given pain relief. This will depend on things such as the cause of your pain and how bad it is. Both drug and non-drug treatments can be used to control pain. Not all pain relief is given as a tablet or injection.

Most pain medicines can have side effects. These are usually not serious and not everyone will get them. Sometimes they can be helped by treatment or by changing to a different drug. Your doctor should tell you what to look out for when taking any of these drugs, and what to do if you get side effects. If you are not sure about anything to do with your medications, talk to someone from your health care team.

Some people fear that they will become addicted to strong pain medications such as morphine, oxycodone or pethidine. However, the risk of this is very rare, especially in people who have not abused drugs in the past. If you need to keep taking strong pain relief drugs for some time, the cause of the pain may need to be looked at again.

Pain Relief Medications

The main types of drugs used to treat pain are described below.

Paracetamol

Paracetamol is used to treat mild to moderate pain. It can be combined with other pain medications to relieve more severe pain.

The risk of side effects is low. Therefore it can be used by people who cannot take drugs like aspirin (eg people with asthma or stomach ulcers).

Healthy adults should not take more than 8 tablets a day. Each tablet is 500 mg. People with liver disease should only take paracetamol after asking their doctor. The dose given to children depends on their age and weight.

There is now a form of paracetamol that can be given by injection.

Anti-inflammatory drugs

These include non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors. Examples of NSAIDs include aspirin, ibuprofen, naproxen and indomethacin. An example of a COX-2 inhibitor is celecoxib.

Anti-inflammatories are used to treat mild to moderate pain. They can be combined with other pain medications to relieve severe pain.

Side effects are more common with these drugs than with paracetamol. This may limit their use in some people. Some of the serious side effects are kidney problems, stomach ulcers and bleeding.

In general, the risk of side effects is the same regardless of whether the drug is given by tablet or suppository.

You should not take anti-inflammatories without talking to your doctor if you:

• are aged 65 or older
• have had a stomach (gastric) ulcer or bleeding
• have had asthma
• have had kidney problems
• have had problems with anti-inflammatories before

COX-2 inhibitors control pain as well as NSAIDs. They may cause fewer gastric and bleeding problems, especially when used for a short time. However, they can have similar effects on the kidneys.

Opioids

These include codeine, morphine, oxycodone, pethidine, fentanyl and tramadol. They are often used to treat moderate to severe acute pain after surgery or injury. The dose that is needed varies a lot between people. Doses are worked out for each person based on their age and other factors.

If you become too drowsy your breathing could be affected. In hospital, you will be checked regularly. If you become too sleepy, the dose of opioid may be reduced. Other drugs that cause drowsiness (for example, sleeping tablets) can increase the risk of breathing problems. You may not be able to take these as well as opioids.

Drugs such as paracetamol and NSAIDs may be given to you as well as opioids. This can reduce the dose of opioid needed to treat your pain.