Pain management in hospital
Summary:
- Pain can affect your mood, your sleep, and your ability to move around and to think clearly.
- Pain that is not managed can slow your recovery and lengthen your stay in hospital.
- Pain is not a part of life you have to adjust to.
- Pain is not a normal part of aging.
Information:
- Definition of pain
- Your pain should be managed while in hospital
- You can help hospital staff to manage your pain
- Techniques to manage pain in hospital
- Pain relief after you leave hospital
- Where to get help
Pain can affect all areas of your life: your mood, your sleep, and your ability to move around and to think clearly. While many people will experience pain in hospital as a result of their condition or during recovery from treatment such as surgery, this pain needs to be managed. Controlling pain helps your recovery and there are many things you can do to help.
Pain should not be considered a part of life that you have to adjust to, nor is pain a normal part of aging.
Pain is often categorised as acute pain, which has a definable cause and should cease once the cause has healed, or chronic pain, which lasts well beyond the period of healing. If you have pain, talk to your nurse and doctor so that they can treat the cause of it and treat the pain itself.
A recent scientific paper published in the ANZ Journal of Surgery found that patients are not provided with sufficient information when discharged from a hospital with opioids—but the Choosing Wisely 'Managing pain and opioid medicines' resource for use in hospitals is helping address this patient knowledge gap.
MANAGING PAIN AND OPIOID MEDICINES
https://www.choosingwisely.org.au/assets/CW-Patient-resource-Opioids_1.pdf
Well worth printing out so you know what to expect when you have to go into hospital. And what questions to ask.
In hospital
Pain is a common experience when you are in hospital. Talk to hospital staff about how pain is affecting you, so that they can help keep you as comfortable as possible. There are many ways to treat pain, with and without medicines such as paracetamol and ibuprofen. You have been prescribed an opioid, a type of pain medicine (eg, oxycodone, tramadol, morphine). These medicines work well for short-term pain but they have significant side effects and can be addictive.
Ask your health professional
- How long will the pain last?
- How much will this medicine reduce the pain?
- It’s important to only use opioids for the shortest time and at the lowest dose possible.
- Leaving hospital Before you leave hospital, make sure you ask your health professional these 5 questions and any others you may have.
- 1 What is causing the pain? The cause of the pain and how long it is expected to last depends on your situation.
- 2 What are the risks and benefits of this medicine? Opioids reduce pain – they won’t take the pain away completely. Any benefit needs to be weighed against potential harms. Opioids have major side effects, including the possibility of dependence and overdose.
- 3 How long should I take this medicine? Opioids should only be used for the shortest time and at the lowest dose possible. Discuss with your doctor or pharmacist when you can lower your dose or stop the medicine altogether.
- 4 Are there other ways to manage the pain? There are lots of effective and safer ways to manage pain, such as building activity slowly, gentle exercises and relaxation. Most people need to use a combination of strategies.
- 5 What is my pain management plan? Work with your health professional to develop a plan that works for you. You can use the pain management plan template over the page
Pain management plan
There are many ways you can manage pain and speed recovery. Work with your health professional to create your personal pain management plan.
Physical (body) Psychological (mind) Social (lifestyle)
¥ Build activity slowly ¥ Relaxation ¥ Stop smoking
¥ Physiotherapy ¥ Mindfulness ¥ Reduce alcohol
¥ Yoga or other gentle exercises ¥ Distraction ¥ Better sleep habits
¥ Massage ¥ Cognitive behavioural therapy (CBT) ¥ Stay socially active
¥ Heat or cold pack ¥ Healthy eating
Pain medicines
¥ Paracetamol
¥ Anti-inflammatory medicine
¥ Opioid
¥ Other
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Definition of pain
Every person’s experience of pain is different. Pain can be associated with a physical injury, but it can also be an emotional response. Talking about your pain and how you are feeling is very important. Some people think that they just have to accept pain, and that talking about it won’t help. But there are ways of managing pain if you tell your healthcare team about it.
Pain does not feel the same for everyone. Describing your pain clearly will help your doctor or nurse find the best treatment.
A person may describe pain by:
how strong pain feels (such as dull or intense)
- the nature of the pain (such as an achy feeling or a sharp pain)
- by location (where you feel the pain in your body)
- an emotional response (such as unpleasantness, fear, exhaustion, frustration or anxiety)
- its impact on aspects of daily life (such as getting dressed, mood disturbance, social relationships and leisure activities).
Acute pain is pain that lasts for a short time (such as days or weeks) and is common following surgery or physical trauma such as damage to skin or muscles tissues. Acute pain usually goes away after the damaged area is healed.
Persistent or chronic pain is pain that extends beyond a normal healing period (traditionally beyond three months). It can exist without a clear reason at all, for example with a condition where healing is not expected to occur. Chronic pain is recognised as a condition in its own right, not just a symptom.
Identifying the underlying cause of a person’s pain while they are in hospital is important so that staff can treat and manage that pain effectively. Treatment will vary according to the type of pain, but will involve a combination of medication and other approaches.
People in hospital may experience discomfort or acute pain as a result of surgery or some procedures. Pain should always be reported to hospital staff, because it can be managed during your stay and addressed as part of your discharge plan.Your pain should be managed while in hospitalSome people are reluctant to acknowledge and report pain, but pain that is not managed can slow your recovery and lengthen your stay in hospital. Unmanaged pain can also mean you become less mobile and less independent. Uncontrolled pain can make you more likely to become depressed, anxious or isolated from others. It can also make it harder to do everyday activities.
You can help hospital staff to manage your pain. You don’t have to put up with acute pain during your time in hospital, so make sure you speak up and tell staff about how you are feeling.
The most accurate information about your pain comes from you. Tell hospital staff if you feel any pain and:
- where the pain is
- how strong the pain is
- the type of pain you have (for example, aching, throbbing, stabbing)
- the activities that make the pain better or worse
- how the pain affects your daily activities (for example, your appetite, sleep, mood, ability to move around).
If you are in pain, ask for pain relief as soon as it starts. It is better to have pain medication regularly than to wait for the pain to get bad.
Hospital staff may often ask you if you are in pain or do a formal pain assessment. Answer the questions honestly and to the best of your ability.
Ask your nurse for pain medication half an hour before any activity that you know will make your pain worse.
Techniques to manage pain in hospital
Ask staff for information on ways to help reduce pain. You, your family and carers should take an active role in planning your treatment and setting goals.
Treatments for pain usually include both medication and other therapies, such as:
- gentle exercise
- applying heat or cold packs
- manual therapies (for example, physiotherapy or massage)
- relaxation.
Try and find enjoyable activities that don’t worsen your pain and that help to take your mind off it. Stay as mobile as you can. Resting in bed for long periods will increase pain and put pressure on your skin. You will also lose muscle strength and become less mobile over time.
Pain relief after you leave hospital:
If you are prescribed pain-relieving medication to take after leaving hospital, be aware that there are some common side effects, which can include:
- reduced alertness
- constipation.
Ask your doctor about the medication you have been given, what side effects you may experience and what you should do if you experience any of these side effects. You can also ask your doctor for the Consumer Medicine Information sheet, which provides detailed information about the medication you are talking.
Where to get help
- Your doctor
- Hospital nursing staff
- Allied health staff
- Patient liaison officer
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.
with sincere thanks for such well resourced information. Victoria State Government, Health and Human Services
Last updated: September 2015
Pharmacist review, home checks part of medication strategy for people with dementia
By: Dallas Bastian in News, Top Stories August 4, 2017
Australian researchers are hoping to improve outcomes for people with dementia after they are discharged from hospital through a medication strategy that starts in the lead-up to discharge and continues into the home.
Associate professor Ashley Kable, from the University of Newcastle, said medication generally changes for people once they’ve been treated in hospital, which makes self-administration even harder for people with dementia, and added the responsibility often falls back on carers.
Kable said currently, home medication reviews can be requested by a general practitioner following a patient’s discharge from hospital, but are not always done. She said the safe medication strategy will include clinical pharmacist review of medications and communication with the carer, training in hospital to use medication dose administration aids and provision of a discharge medication plan and explanation.
The discharge summary will include a note for general practitioners to request a home medicines review. These will be conducted by community pharmacists who will aim to identify any prescribed medications that may be a risk for people with dementia, such as those that may cause confusion or result in falls, any potential drug interactions or contraindicated medications, any adjuvant medications being used in addition to prescribed medications that may be a risk, and any modifications to medications that may be required for a person with dementia.
SO, when your loved one is discharged from hospital, do make sure to go to your usual Pharmacist and ask for a Home Medicines Review. Many of the usual medications may have been changed, upped in dosage, or Brand altered in the hospital. YOU, need to know as the result can be most serious for your loved one. YOU, as a Carer, can do this. Alternatively, have a chat with your loved one's GP and have him write a note to your Pharmacist to do this.
How the pharmacist can simplify a dosing schedule during an Home Medicines Review:
• Reduce dosing frequency and recommend long-acting dosage forms where possible
• Recommend a higher strength to reduce the number of dosage units for a specific medicine where two tablets of the same medicine are taken at different times in a day
• Recommend a lower strength product where the person is cutting tablets in half or into quarters
• Consolidate dosing times to fit in with the patient’s lifestyle
• Recommend a combination product if suitable to reduce the number of medicines being used
• Recommend a suitable adherence aid for the patient with cognitive or dexterity issues
for a closer look:
https://www.veteransmates.net.au/documents/10184/38810/Nov_2016_GP_Insert.pdf/e9b3126e-bf0e-4238-bd74-8cdd617458d0
"With the focus on medicines and older Australians in these lists, we urge people to consider if they are on the right medicine, or whether they could be taking too many medicines and if you are due for a review. It’s always timely to check with your doctor or pharmacist to see if any medicines are unnecessary and if they could cause harm if taken together."
29 April 2018