Most people fear being in pain. The simple fact of fearing that pain is going to increase may in itself make the pain worse. It is difficult to think and make decisions when you are in pain or frightened that pain will return.
There are several steps involved in feeling and reacting to pain:
- Certain nerves throughout the body have endings known as pain receptors. These can be activated by pressure from a tumour or by chemicals released from damaged tissue.
- The pain receptors then send messages along the nerves, first to your spinal cord and then to your brain. When painful messages reach your brain, you feel pain.
- The brain responds by sending other messages back along the nerves to direct your reaction. For example, if you feel pain when you move your arm, you may react by keeping it still.
The brain can change the way you feel pain. Parts of the brain that control our emotions can increase or decrease the sensation of pain. So if you’re anxious you may feel more pain, and if you’re relaxed you may feel less pain. Sometimes the nerves carrying messages to and from the brain become ‘sensitised’ or ‘wound up’. This means that you continue to feel pain even when what was causing the pain has been treated.
For more information on Pain, please see the list of topics below.
There are many painkillers available to treat different types and levels of pain, whether it’s mild, moderate or severe. Painkilling drugs are known as analgesics. Your medical team will aim to find the right combination of painkillers and other therapies to ensure that your pain is managed in the best possible way. Some people have constant pain, so they need to take painkillers regularly to keep the pain under control. It’s important not to let pain build up until it’s severe. Severe pain can cause fear, anxiety and difficulty sleeping, which can make the pain worse and more difficult to control.
Painkillers taken by mouth (oral medicines)
Painkilling drugs are usually taken by mouth, as tablets or capsules. For people who find it hard to swallow, many oral medicines are available as liquids and some can be dissolved in water. If you have a feeding tube, such as a PEG or RIG tube, some liquid or soluable painkillers can be given through the tube.
Other ways to take painkillers
There are several other ways of taking painkillers that can be helpful if you can’t swallow or are being sick:
These are stuck on to the skin. They are useful when your pain control is more settled and only need to be changed every few days.
Buccal and sublingual medicines
These are absorbed from the tissues in the mouth, so they don’t have to be swallowed. They are usually used for controlling breakthrough pain, as they work quickly.
Some painkillers can be sprayed into the nose. These work best for breakthrough pain.
These are inserted into the back passage.
Many painkillers can be given by injection, either into a muscle or more usually under the skin (subcutaneously).
This involves using a small portable pump known as a syringe driver to give a continuous dose of a drug or drugs into a fine needle or plastic tube called a cannula placed just under the skin.
Intravenous infusion using a patient-controlled analgesia (PCA) pump
In hospital, for example after surgery, you may have a PCA pump to control your pain. A tube is placed in a vein in your arm or the back of your hand and connected to the pump, which has a handset that you press to give yourself a set dose of a painkiller, usually morphine. You can press the handset as often as needed to ensure your pain is controlled.
Occasionally painkillers may be given by infusion into the space just outside the membranes surrounding the spinal cord. This is known as epidural analgesia. Sometimes the painkiller is given into the fluid around the spinal cord - this is known as intrathecal analgesia. These specialised techniques are usually used only to control severe pain and are managed by anaesthetists. If you need to have your painkillers by injection or infusion, your doctor or nurse will discuss this with you. Please see our leaflet on Strong Painkillers for more information.
It’s very important to store painkillers carefully. Make sure they are properly labelled, and lock them up or keep them out of reach of children. If you’re worried about forgetting to take them, write a note to yourself and put it somewhere you will see it rather than leaving the medicines out. Alternatively, you could ask your partner, relative or friend to remind you to take them, or create an alarm on your computer or mobile phone and title it ‘Painkillers’. Always return any unused medicines to a pharmacist, who can dispose of them properly.
Tips for managing pain at home
It is important to always report any new pain to your doctor even if you think you know the cause. If pain is treated early it may be managed with less medication or other treatment. Some useful suggestions to manage pain which you can discuss with your doctor and your local palliative care services include:
Pain medications – their dose and frequency of use
Keep a pain diary, use cold/warm packs, use breakthrough painkillers and physical aids. Ensure you take your pain medications regularly and take breakthrough doses as and when needed.
Frames (bed cradles) to keep linen and blankets off a painful area
Back supports to make sitting more comfortable for you. Ask to speak to a physiotherapist or occupational therapist who can advise you on what is available.
Positioning yourself well can relieve pain
Constipation can make discomfort and pain worse and preventing constipation can prevent pain.
Distraction can be useful – conversation or a good book or film.
When to call for help
- Any time you are worried
- When there is a new pain or worsening of an old pain
- When sleep is disturbed by pain
- When the painkillers do not seem to be working very well or for very long
- When the painkillers are causing troubling side effects such as sickness, constipation, drowsiness or confusion.