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All about pain


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Why pain?
Why do we feel pain?

Pain is what we feel when our bodies are in danger of being injured, are being injured or have been injured. It is a protective mechanism designed to prevent you from harming yourself inadvertently. When you come into contact with fire, for example, you feel pain before any injury has actually occurred. It is unpleasant so you will do something to forget all other actitivities and protect yourself from injuring your body, or minimise any further injury. Pain that occurs once you are injured is designed for you to take protective measures with the sore part of your body to help heal it - if you have a cut on your hand and keep bumping it the wound will keep breaking open.

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How painful?
How much pain will I feel and for how long?

The severity of the pain you actually feel will never be great because you will get pain killers during the anaesthetic and will wake up having had some form of pain relief, which will be continued after the operation. How painful an operation is depends on the type of operation and the person's response to the pain. The more pain you might feel, the stronger will be the pain relief you get. Even the most painful operations usually leave you with only minimal discomfort that you can ignore after a week. In that time you will be receiving some form of pain relief so you should never feel severe pain.

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Harmful?
Is pain harmful? Is a little bit of pain good?

Pain is a protective mechanism and it is not supposed to harm you. Pain does cause certain changes in body chemistry which are involved in the "flight and fight" reflexes in order for you to react to the pain. The changes in body chemistry do cause stress to the body. While the pain itself will not harm you, the changes in body chemistry increase the amount of stress your body must deal with. Because of this, when pain is no longer protective - as in the case of after an operation - the pain does actually harm you. When you are in pain, you tend to minimise the amount you move your painful body parts. When you have had an operation this is detrimental. If you cannot take deep breaths and cough because of a sore abdomen, then you are at greater risk of getting a chest infection. Also if you do not get up and walk around you are at greater risk of getting a blood clot in the legs. In the setting of an operation, pain is only harmful. The myth of "a bit of pain is good" does not apply with an operation. You do not need to earn your pain relief. In rare circumstances people develop chronic pain which is when pain long outlasts any actual body injury. This is an abnormal response by the body. Anaesthetists have special interest in chronic pain control. If you have some sort of chronic pain seek help.

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Pain Relief
How can pain be controlled?

There are numerous different ways pain can be relieved. Pain relief can be administered according to the severity of pain, and with various different routes of administration. Medications can be taken by mouth, suppositories put in rectally, patches can be worn, drugs can also be injected into muscles, veins or near nerves in the body. A combination can be (and often is) used. The main problem with all forms of pain relief is they usually need to be fine tuned initially to suit your needs, but rest assured that virtually all pain can be controlled.

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Tablets
Panadol, Panadeine and aspirin

The simplest form of pain relief are tablets containing paracetamol (Panadol) or aspirin (Dispirin) or suppositories. While these are easy to take and have a low incidence of side effects they also are only weak pain killers so are suitable for the mildest forms of pain. A step up in pain relief is a mixture of paracetamol and a stronger pain killer like codeine (Panadeine) or dextropropoxyphene (Digesic). The more of these stronger pain killers that is included the stronger the tablet, but also more side effects can occur. These drugs tend to cause drowsiness, constipation and sometimes nausea. Anti-inflammatory drugs can also be taken in this manner. You need to be able to swallow without being nauseated to take these tables, and they are limited in how strong the pain relief is. They are often used to supplement other forms of pain relief.

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Intramuscular injections
Injections into the muscle

When most people think of injections this is the sort they expect. The strongest pain killers that exist - like morphine - can be given this way. The advantage is that you don't need to be eating or drinking, strong pain can be relieved and there is less constipation. The disadvantages are that nausea and drowsiness are much more common with these drugs, you have to endure repeated (usually 4 hourly) injections and the painkillers start wearing off before you get any more. Intramuscular injections hurt less than having blood taken but sometimes the medicines in them can sting where they are injected.

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Intravenous
Injections into the vein or drip

When someone has a drip, the same drugs injected into the muscle can be given directly into the drip. The advantage of this is you don't have to endure repeated injections (only the first one when the drip goes in), and pain relief is constant because the drug is continually infused into the drip. This is called the intravenous infusion. The disadvantage is you need special equipment, and constant supervision because the infusion of these drugs in this manner has to be done carefully to prevent overdose and to ensure pain relief. A variation of this is when you are given control of the pain relief. You carry a small button which is connected to the infusion and each time you press the button you get a small boost of pain killer into the drip. Because different people have different response to pain and pain-killers this method is better because it is tailored to you. This is called patient controlled analgesia or PCA. When using this, if you are uncomfortable, you press the button. If you are still uncomfortable, you press it again, and again.. till you are comfortable. You cannot overdose with this system as you will get drowsy and sleepy before you get to dangerous levels of pain killers.

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Addiction
Will I get addicted to pain killers?

Many people are concerned that they may get addicted from getting these strong pain killers while they are in hospital. Addiction is a process that actually takes some time to occur. The physical addiction to pain killers is one where the body "gets used to" having the drug in the system and then has withdrawal symptoms if it is stopped. This sort of addiction usually takes weeks to develop. Most people have strong pain killers for about 3-5 days. In that time you will not get addicted to pain killers. Fear of addiction is no reason to avoid getting good pain relief. There is no reason to limit the amount you have in that time either. If you are already addicted to pain killers your body needs much greater doses of pain killers to work, and it's never quite as effective as previously. If you do have some sort of addiction it is vital your anaesthetist know about it to tailor a way to ensure good pain relief and minimise the risk of worsening your addiction.

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Epidural
Epidural infusions for pain

An epidural infusion is a very powerful way to give pain relief. Afer an epidural has been placed, local anaesthetic and pain killing drugs can be slowly infused into the epidural drip. This can make you completely pain free over the area where the operation has occurred. The major advantages are that drowsiness, nausea and constipation usually don't occur, and you can usually eat and drink sooner. The disadvantages are that you have to have one put in initially (adding to the procedures performed on you), they require careful monitoring also (as different side effects occur), weakness in the legs preventing you from being able to get up often occurs, and a catheter is often needed because of lack of feeling.

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Other
Patches, nerve block catheters etc...

Skin patches are now available that give strong pain relief. They actually contain the same drugs that are injected but work by slowly seeping through the skin. Similar side effects to the injected drugs occur. The major advantage is the simple administration without injections. The major disadvantage is they start working very slowly so something else needs to be given first, and the stop working slowly so if side effects occur then they will continue to occur for some time after the patch is removed. Special drips can be placed near nerves when nerve blocks are performed, and local anaesthetic drugs can be continually infused there to improve pain relief. There are numerous other ways to give pain relief and this is by no means an exhaustive list. These are the most commonly employed forms of pain relief but your anaesthetist will discuss with you what they think is best and other options when they are available. Remember that just because one form of pain relief has been chosen for you does not mean you can't change to something else later on. It is common practice to start with the stronger pain relief and change to the weaker ones as the pain lessens.

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  Back to Top Site created by Con Kolivas Jan 2001
 

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