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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 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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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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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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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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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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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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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 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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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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