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Learn more about management Learn more about pain management

Pain is unpleasant sensation, or distress of the body or mind. Pain hurts and it can wear you down, make it hard for you to be active and make you feel tired and tense. Pain often accompanies cancer and other progressive and it can affect the psychological, IT IS IMPORTANT emotional and spiritual aspects of your life. TO SPEAK UP ABOUT YOUR PAIN AND YOUR FEARS ABOUT PAIN Why are we afraid of pain? They value stoicism and don’t want to appear weak Not all people living with a terminal People interpret their pain according illness experience pain. However, to their particular life experiences, many people living with a terminal values and beliefs. If you value illness are afraid of pain because they stoicism for religious or cultural worry that pain cannot be controlled reasons, you may wish to discuss the without awful . matter with your religious leader or Fear of pain adds to the total impact a pastoral carer. None of the major of pain. It is important to speak up religions urges its followers to reject about your pain and your fears about pain-killers () in terminal pain. Be honest and ask questions illness. If you think that it is weak to so that you can be given accurate ‘give in’ to pain, you might consider information. whether analgesia will free your energy for more important things. Can pain always be They think increasing pain might be controlled? a sign of a worsening condition Sharing your fears about your Most pain can be relieved or condition with the controlled. Bringing pain under team can lessen your concern. Even if control and keeping it there means your situation is not good, discussing assessing each aspect of pain and it may reduce your anxiety. it. These are core skills of palliative care doctors and nurses. They think that they won’t have a say about their pain control How can I help control Control of your pain is negotiated between you and your doctor and my pain? nurses. Pain control plans are tailored to meet your particular needs and are Good pain control requires good adjusted as your needs change. communication amongst patients, carers, medical and staff. It You have the say as to whether you is important to be open and share want more or less pain relief. information so your care team They are afraid that if they have knows exactly what is happening strong pain-killers now, there will be with your pain. nothing strong enough for them later Sometimes people report less pain There is no set limit to the amount of pain than they experience because: relief offered. You cannot ‘run out’ and it can always be increased or decreased according to your experience.

2 Learn more about pain management www.palliativecare.org.au How is pain controlled? • such as , relaxation, meditation, , Medications are the foundation of pain music , aromatherapy, control. There are two main groups and acupressure. of pain ranging from mild • Distraction – any activity that pain relievers such as and diverts and holds your attention , through to medium and will lessen your awareness of pain. strong relievers, such as and related drugs (). Complementary measures are used as well as medical treatments. They Anti-inflammatory, anti-depressant increase the effectiveness of drug and steroid medication may also therapy and may reduce the amount have a complementary role for some of medication required. patients and some sources of pain. The right mix of medications is part If I take strong pain-killers of the expertise of the palliative (opiates), will I become care team. addicted?

Must I take medication? People sometimes think that opiates must be addictive because they Medication is the core treatment come from the same source as of pain in terminal illness. , (). Heroin, injected radiation and ‘’ (like a into a vein, gives a rush of pleasure, local anaesthetic) are used to control called euphoria, which can be pain in some cases. highly seductive. People who inject When regular (e.g. 4, 12 or 24 hourly) themselves in this way for no medical pain medication has been prescribed reason can become addicted and for you, you must take it on time. will need increasing quantities of the Do not wait to experience pain. The drug to remain euphoric or to avoid schedule is designed to prevent pain withdrawal symptoms. from occurring, not to treat it after it Medically prescribed opiates are used arrives, since this type of pain tends in a very different way. The dose to be with you continuously. neutralises the pain. It does not give Other measures include: a ‘rush’. The chemical effect is taken up by the pain so that any feeling of • Hot packs, cold packs. euphoria is very mild or not noticed. • Careful positioning and Medication is given in the easiest way, repositioning, appropriate usually by mouth (as a liquid, or support for a painful body part. or ), by injections (into skin, • Special physiotherapy techniques, muscle or vein) or on the skin (in a such as laser therapy and patch quite like a nicotine patch). ultrasound. Some patients will remain on the same dose even though their is progressing. Others need increasing doses of pain relieving medication. This is not evidence of addiction. The correct dose is the one that stops PAIN IS A SYMPTOM your pain and makes you comfortable. MOST FEARED BY PEOPLE People vary, vary and there is no LIVING WITH A TERMINAL one right dose for everyone. ILLNESS, BUT OFTEN IT IS NOT A SOURCE OF WORRY FOR THOSE RECEIVING PALLIATIVE CARE.

3 Learn more about pain management www.palliativecare.org.au What are the side-effects What about breakthrough of opiates? pain?

Morphine and similar drugs cause There may be times, even if you receive ongoing constipation,which can regular or continuous pain relief, be controlled with laxatives. Some when you will experience pain. This is people experience nausea,sleepiness called breakthrough pain and is very or confusion when they first take distressing for you and your carer. these medications, Your doctor will probably have For some people this can last up to prescribed extra medication to be taken five days. These symptoms usually as required. In this case take the extra clear up when the person adjusts to medication, make a record of it, and the medication; you can always discuss make sure you tell the nurse or doctor. these symptoms with the doctors and If extra medication for breakthrough nurses helping you with your care. pain has not been prescribed, get help from your palliative care team or GP A few people experience continuing, without delay. unacceptable side-effects. In such cases other drugs are used, or low Sometimes breakthrough pain means doses of two or more drugs are that you need extra (or different) combined to relieve pain without the medication before some planned side-effects. Palliative care event requiring extra exertion or are specialists in pain control. If your effort, such as showering. Often it pain control is less than perfect, seek means that your regular medication specialist advice. needs to be increased so that you remain comfortable. Does morphine suppress The goal of pain management is to breathing? prevent pain; it is more difficult to try to control pain once it has recurred, An overdose of morphine in someone than to routinely treat it before you not accustomed to taking it, may experience it. YOU CAN FIND MORE suppress breathing but in most cases Pain is a symptom most feared by SUPPORT INFORMATION if the morphine has been properly people living with a terminal illness, AND RESOURCES LIKE prescribed this will not occur. Indeed, but often it is not a source of worry THIS ON OUR WEBSITE morphine can be used in low doses for those receiving palliative care. to ease difficult breathing and to Modern pain management means that suppress chronic cough. patients can expect to remain virtually pain free throughout their illness.

Acknowledgement: PCA acknowledges the assistance of Palliative Care Victoria and Palliative Care Queensland in the production of this resource. Disclaimer: PCA advises the information in this brochure is not clinical advice. Your decisions are best made in consultation with your practitioner. PCA provides these links for information purpose only. It is not responsible for the content of these websites.

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September 2018