Controlling your pain in hospital and on discharge

Each person’s experience of pain is different, even after the same operation or with the same illness. Although it may not always be possible to completely get rid of your pain, you should be comfortable. If there is a problem, you can ask the nurse looking after you to contact the Inpatient Pain Team.

It has been shown that when pain is well controlled you get better more quickly. If you are in pain you may have problems moving around, taking a deep breath or coughing. Good pain relief will help you recover and may mean that you leave hospital earlier.

The nurses on the ward will ask you regularly about any pain you have and how bad it is. If you have pain at any other time, or the pain won’t go away, it is important that you tell the nursing staff.

Your pain will be treated with a combination of painkillers, physiotherapy and keeping well hydrated. Treating pain in this way aims to reduce the amount of strong painkillers you need which will help to reduce the risk of side effects.

Morphine and oxycodone

You may be prescribed morphine or oxycodone as an injection or liquid. Injections will only be given if you are ‘nil by mouth’. Injections will be given through a small cannula which is placed in your upper thigh.

Strong painkillers are given for moderate or severe pain. If you are experiencing moderate or severe pain, tell the nurse who will give you an injection or liquid painkiller. Strong painkillers are only recommended for short-term use as they can cause harm if they are taken for a long time.

Oxycodone is used for patients that are allergic to morphine or when the side effects of morphine are unacceptable.

Most painkillers have side effects, they can cause slight drowsiness but this is normal. Morphine and oxycodone can also cause constipation. Very rare side effects include bad dreams or hallucinations. Some patients may feel sick and this can be treated if it occurs. If you develop any of these side effects, please tell your nurse.

PCA (Patient Controlled Analgesia)

If you are having surgery, or are admitted to hospital in pain and need frequent injections of morphine, an alternative to injections would be a PCA.

Having a PCA means that you can give your own strong painkiller, which is connected to your drip. The nurses on the ward will ask the Inpatient Pain Team to see you if you have a PCA. There is a separate information leaflet you will be given about the PCA method of pain relief. The benefit of a PCA is that you are in control and don’t have to wait for the nurses to give you painkillers.

Epidural / spinal / local anaesthetics

These are alternative methods of pain relief that you may be offered if you are having major surgery, or have fractured ribs. If you are offered this type of pain relief there is a separate information leaflet explaining all about it. The benefits of these methods are that they can provide excellent pain relief, reduce nausea and vomiting and improve your ability to move about in comfort.

Paracetamol

Paracetamol is a very effective painkiller when taken regularly and can reduce the amount of strong painkillers you will need. It rarely causes any side effects when taken in normal doses.

Tramadol, codeine, dihydrocodeine & nefopam

You may be prescribed one of the above types of painkillers in tablet form. The nurse will give you these three or four times a day. You do not have to ask for these but if you do not receive them, please ask the nurse. These painkillers are for moderate pain. The main benefit of these painkillers is that they work for a longer period of time than the strong painkilling liquid or injection and will reduce the amount of strong painkillers you will need.

Side effects of tramadol, codeine, dihydrocodeine & nefopam

These painkillers can sometimes cause nausea but this can usually be treated. Codeine, dihydrocodeine and tramadol can all cause constipation, if this occurs it is important to inform the nurses as constipation can be treated. All of these painkillers can occasionally cause light-headedness, reducing the dose or changing to an alternative painkiller will normally resolve this.

Anti-inflammatory painkillers

These can be very effective for mild to moderate pain, and should be taken regularly. They can be given by tablet, or as a suppository (into your back passage). Occasionally they can be given into your vein through your drip.

You may be given these in addition to other painkillers. There are several anti-inflammatory painkillers used in the hospital, such as ibuprofen (also known as Brufen or Neurofen) and diclofenac.

The benefits of anti-inflammatory painkillers are that they reduce inflammation as well as pain, and they also reduce the amount of strong painkillers you will need. A common anti-inflammatory painkiller prescribed by GPs is naproxen; you must not take naproxen with ibuprofen or diclofenac.

Side effects of anti-inflammatory painkillers

Anti-inflammatory painkillers can cause indigestion. If you develop indigestion whilst taking them please inform the nurse.

Yes, in the first few days after surgery, trauma or an acutely painful condition, painkillers work better if taken on a regular basis before your pain becomes severe. The aim is to keep your pain under control, not to wait until it is severe before treating it.

It is rare to become addicted when you are taking painkillers to treat pain for a short period of time. Long-term use of strong painkillers is not recommended.

If you are on morphine or oxycodone for more than two weeks, it must not be stopped suddenly but reduced slowly. Ask your GP for advice about this.

You are no longer advised to take codeine if you are breastfeeding; we now recommend dihydrocodeine for breastfeeding women as it does not contain codeine.

Although it is very rare, dihydrocodeine can pass into breast milk resulting in drowsiness, vomiting and poor feeding. If you are at all concerned about this, or your baby has any of these symptoms please contact your community midwife or GP.

Yes, there are other ways to help control your pain, such as listening to music, relaxation and reading. These techniques can really help.

Reading a book or magazine can help you relax and the hospital patient’s library has lots of these for you to borrow whilst you are in hospital.

Listening to music - you could bring in an iPad or phone filled with your favourite music but remember to bring in your headphones.

Changing position can help make you more comfortable, the nurses can help you find a comfortable position.

For most people, once the short-term supply of tramadol, codeine, dihydrocodeine, nefopam and anti-inflammatory painkillers have finished, paracetamol will be enough, unless you are already taking them for a long-term condition.

If you experience moderate or severe pain, despite taking regular paracetamol, that is stopping you from deep breathing, coughing and moving around, consult your GP. However, it is usual to get some pain following surgery, trauma or following an acutely painful condition.

Before you are discharged if you have any concerns about your pain or the painkillers that you are taking, please speak to one of the nurses or doctors looking after you.