If you have pain most of the day then you need to take regular medication. Here, the goal is to prevent pain rather than wait until the pain gets bad enough that you need medication. If you wait until the pain medication "wears off" and the pain gets bad again, you will have periods of unnecessary pain. As well, it will take longer to get the pain under control than if you take the medication regularly (see Figure 1). Taking pain medication regularly prevents pain from developing and provides smooth pain control.
The timing of your regular dose is adjusted according to how long the medication works, for example:
Your pain will vary throughout the day, depending on your activity level, fatigue, or other factors. Because it can vary, pain will at times "break through" the pain control. If this occurs, you should have a short-acting pain medication to take. Again, don't wait until the pain gets severe. Earlier treatment results in easier control. If the pain breaks through more than 2 or 3 times a day you may need an increase in your regular dose of medication.
The common side effects of opioids are constipation, drowsiness, nausea, and dry mouth.
Almost everyone experiences some constipation. This is because opioid receptors in the large and small bowel respond to the opioid by slowing down the action of the bowel muscle. The result is hard, dry stool that is infrequent and hard to pass. Some people dread constipation as much as they do the pain. However, constipation can be prevented by increasing fluid intake, dietary fibre, exercise, and using laxatives appropriately.
Another common side effect of opioids is drowsiness. It can be very frustrating to doze off in the middle of a conversation. However, this generally lasts only for the first day or two after you start the medication or after a change in the dose. Within a short time, the body adapts to the medication and the drowsiness is gone. Be sure to avoid activities like driving or operating machinery if you experience significant drowsiness. If the drowsiness persists, then you should talk to your doctor. Sometimes a change in the opioid is necessary.
Nausea occurs because the opioid affects the brain's vomiting center. Also, opioids slow down the movement of food and fluids through the stomach, causing nausea and vomiting. Mild nausea will usually disappear in a day or two. If it persists, there are various ways to cope with nausea and helpful medications that can control it. If the nausea is severe or persistent despite treatment, a change in the type of opioid is necessary.
Different kinds of pain require different combinations of medication. For example, if the pain is in the bones, pain control is best when opioids are combined with acetaminophen or anti-inflammatory medications. Pain due to nerve damage will respond best with the addition of steroids to reduce swelling around the nerve, or with an antidepressant to lower the sensitivity of the nerves to pain. Taking an antidepressant for pain does not mean you are depressed. Adding an anticonvulsant drug can also be helpful for treating nerve pain. There are many other helper ("adjuvant") medications that can be used.
It is very helpful for both you and your health care team if you keep a diary to record your pain and your response to the medication.
Gaining control of pain usually requires several regular visits with your doctor or health care team. At the end of a visit, make sure you have a follow-up appointment arranged. Many people feel embarrassed or frustrated to return to their doctor "complaining" of pain. But, by viewing yourself, your doctor, and others as part of a team working to control your pain, you will not feel alone. Your job is to take your medication and keep track of what happens to your pain.
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