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Pain following surgery or injury A guide for patients and carers Department of trauma and orthopaedics, plastics, physiotherapy and occupational therapy This leaflet provides information to patients and their families on understanding and managing their pain whilst in hospital. If you have any further questions, please speak to a doctor or nurse caring for you. What is pain? Pain is an unpleasant sensation which occurs in response to actual or potential damage to part(s) of your body. Many different words are used to describe pain, for example ‘aching’, ‘dull’, ‘shooting’, ‘burning’, ‘stabbing’ and ‘stinging’. The way pain is felt and described is different for each individual. Pain can be either acute or chronic. Acute pain occurs immediately following an injury, for example a broken bone or an operation. This is our body’s way of signalling danger; causing you to stop, rest and seek treatment, and therefore promoting healing. It can last from a few seconds to three months. It is a normal response and will improve as healing takes place. Chronic (persistent) pain lasts longer than three months – beyond the normal healing time of most injuries. This pain is not useful and can lead to longer-term disability and problems with function and movement. Poorly controlled acute pain is the biggest risk factor for chronic pain. It is therefore very important to effectively manage your pain in the early stages whilst you are still in hospital and recovering at home. 2 Why do we feel pain? Pain is a danger signal to your brain. When your nerve endings are stimulated it may trigger a sensation or feeling. If this stimulus goes above a certain threshold, that sensation is felt as pain. If we did not experience pain we would be in danger of doing ourselves further harm as we would not know that our body had been injured. How bad is my pain? Your nurse may ask you to rate your pain as mild, moderate or severe. You may be asked whether there is a difference between your pain levels when you are resting, and your pain levels when you are moving. You may also be asked to rate your pain on a scale of zero to 10. A score of zero would indicate no pain at all, whereas 10 would indicate the worst pain imaginable (unbearable pain). There is no ‘normal’ amount of pain following a certain injury or operation – everybody experiences and rates their pain differently. It is important that you let your doctors, nurses and therapists know if you are in a lot of pain, as they can help you to manage it more effectively. How can I manage my pain? Pain-relieving medications (also called ‘analgesics’ or ‘painkillers’) may be given orally (tablets and medicines), in patches, as an injection or through a drip. Different types of painkillers are effective for different sorts of pain. For example, some painkillers target pain from nerves whilst others are effective for muscular or joint pain. Your medications will be reviewed by your hospital team to ensure you are getting the most effective pain relief, however it is rare that painkillers will stop you from feeling any pain at all. Sometimes you may be prescribed regular pain relief as well as another type of pain relief that can be requested as 3 and when it is needed (before a physiotherapy session, for example). This second type of pain relief may take around thirty minutes to be effective. It is important that you ask for these painkillers because if your pain is preventing you from moving, it is preventing you from getting better. There are many other ways of controlling pain besides medication and we encourage you to take an active role in managing your own pain. Below are some methods you can use: Ice Ice can be used to reduce swelling and inflammation. Your physiotherapist may supply you with a cryocuff (a re-usable ice pack) or you can use a bag of crushed ice or frozen vegetables at home. It is recommended that you use the ice for 15–20 minutes, three times a day. Never place the ice directly on your skin – wrap it in a towel and check your skin regularly for marking/ice burns. Elevation Keeping your painful limb higher than the level of your heart will encourage drainage of any swelling, which can help to reduce your pain. Movement, positioning and exercise Your physiotherapist and/or occupational therapist will teach you exercises to keep the muscles surrounding your injury strong and prevent your joints becoming stiff. Moving the area and regularly changing your position will also help to reduce your pain. It is important to pace yourself when you resume walking or begin new exercises – start slowly and exercise ‘little and often’, gradually increasing how much you do each day. Practicing functional activities, such as making a cup of tea or showering, can also help you to manage your pain once you go home and return to everyday activities. 4 Heat Sometimes heat can be more effective in relieving pain than ice. Heat can be beneficial for muscular aches and pains where there is no swelling. You can use a ‘heat pad’ or hot water bottle for 15–20 minutes, three times a day. Heat should not be used on wounds or where there is swelling following an operation. Acupuncture Acupuncture uses small needles placed at certain points on the body to relieve pain that is not responding to other treatment. Your physiotherapist can discuss this option with you and will decide if it is appropriate for your type of pain. Transcutaneous electrical nerve stimulation (TENS) TENS uses a small electrical current through pads placed on the skin to help block pain signals to your brain. It can be effective in relieving persistent pain. Your team can discuss TENS with you and help to decide if it is an appropriate treatment for you. Massage Sometimes an injured area can become hypersensitive to normal touch, meaning that your threshold for pain is lower than normal. This can be due to many factors including increased firing of nerves and increased inflammatory chemicals in the area. It is possible to desensitise the area by using gentle massage, touching the area with different materials/textures and rubbing in moisturiser or cream. Distraction and relaxation techniques Feeling anxious or scared of the pain may make it feel even worse. Distracting yourself by doing normal day-today activities, talking to friends or being away from the ward for short periods of time can help you to control your pain better. Reducing your anxiety through relaxing 5 breathing techniques, listening to music or watching a film can also help. What if my pain gets worse? Pain is a normal response to injury or surgery. However, you should inform your healthcare team if your pain suddenly increases without any obvious trigger. Sometimes a sudden increase in pain may be due to changes in your activity levels as advised by your physiotherapist and/or occupational therapist. Sometimes, however, it can indicate that something is not right and appropriate investigations may need to be carried out. Remember, if you don’t inform us that you are in excessive pain, we cannot help you to manage it. Contact us If you have any questions or concerns about the medications you have been prescribed for your pain, please speak to your pharmacist or pain nurse. You can also call the Medicines Information Patient Helpline on 020 8725 1033 (9.30am to 5.30pm, Monday to Friday). For further information about non-medical pain management, please speak to your physiotherapist. If your pain continues, please consult your GP. For persistent pain your GP can refer you to a multidisciplinary pain management programme. 6 Notes 7 Additional services Patient Advice and Liaison Service (PALS) PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9am and 5pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough Wing (near the lift foyer). Tel: 020 8725 2453 Email: [email protected] NHS Choices NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health. Web: www.nhs.uk NHS 111 You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Tel: 111 Reference: THE_PFS_01 Published: February 2015 Review date: February 2017 8