Pain: What You Need to Know

This brochure can help you learn more about managing pain. It doesn’t replace regular medical check-ups or your health care provider’s advice. Talk with your health care provider about what your health risk reduction goals should be.

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YOUR RIGHTS AND RESPONSIBILITIES

Pain is the body’s way of telling us that something may be wrong. The two main types of pain are “acute” and “chronic.” Acute pain usually starts suddenly and lasts less than 3 months. Acute pain is usually sharp in quality. It serves as a warning of disease or a threat to the body. Surgery, dental work, broken bones, cuts and burns can all cause acute pain. Acute pain usually disappears when the underlying cause of the pain has been treated or has healed. But for some people, acute pain becomes chronic or persistent. Chronic pain can last for weeks, months, or even years. A simple definition of chronic pain is pain that continues when it should not. One type of chronic pain is neuropathic pain. Neuropathic pain can occur when the nervous system is injured or unable to work correctly. Back pain, shingles, diabetes, and cancer chemotherapy can all cause neuropathic pain. About 100 million American adults experience chronic pain. If chronic pain is uncontrolled, it can have a very negative effect on the quality of your life. Chronic pain can lead to anxiety, depression, stress, trouble sleeping, inability to work, and changes in relationships. The good news is that there are many ways to help you manage and control your pain. Working together with your health care provider or pain management team can help you get control of your pain. And when you are in control of your pain, you can be more active, sleep better, and feel less stressed!

Managing Pain INTRODUCTION

You have rights and a role in your treatment and care.

Everyone feels pain differently. Remember, you are the expert about your pain experience. It is important that you are open and honest when you talk about pain with your doctor or pain management team member. This will help them work together with you to create a plan with best treatment options for YOU!

Your health care team has the right to expect that YOU will: You have the RIGHT to:

1) Be treated with respect and compassion. 2) Have information communicated in a way

you can understand. 3) Discuss all pain management treatment

options. 4) Be involved in developing a pain

management plan. 5) Know the risks, benefits, and side effects of

each treatment. 6) Seek a second opinion or request a pain

specialist.

1) Be honest, open, and not defensive. 2) Speak up and communicate. 3) Measure your pain by using a pain

rating system. 4) Work with them to establish the plan. 5) Follow your plan for an adequate

amount of time. 6) Follow rules or procedures. 7) Notify them about side

effects.

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Tips for Explaining Your Pain

Be prepared. Your pain management team may have asked you to keep a record about your pain:

Where it is located on your body When it occurs How it feels What helps it get better

It is important to bring this record with you to your appointments. You should plan to answer questions and describe your pain history and how pain is affecting your life.

Choose one person on your pain management team to manage all parts of your treatment plan. This person can communicate and coordinate with the other team members so everyone is aware of the overall pain plan and goals.

Write down any questions you plan to ask, and remember to bring the list to your appointment. It may help to bring someone with you to write down information so you don’t have to worry about remembering everything. If your health care provider seems rushed or distracted, ask if you can speak to another member of your pain management team. Your health care provider may also give you written information that you can read later at home.

Understand that pain is an emotional experience as well as a physical one. You may have had unsuccessful experiences with pain management in the past. Try not to let negative experiences get in your way now.

Speak up. It is important to tell your health care provider if:

You are having any side effects to medicines Your pain is better or worse Your pain feels different than before

Ask questions if you don’t understand. Be honest about your concerns. Be an active member of your pain management team!

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Pain Management Strategies There are many different methods used to manage pain. Lifestyle changes in physical activity and diet, stress reduction, better sleep, and social support may be helpful. Some people need pain medicine. Complementary therapies such as acupuncture and massage work for others. Working with your pain management team will help you find what works best for you!

Physical activity is an essential part of managing chronic pain. It is important that you work with your doctor to find the activities that are best for you. When you begin a new physical activity, your pain may get a little worse at first. It takes patience and persistence but don’t get discouraged! Over time, physical activity strengthens your muscles and bones. It improves your balance, flexibility and mobility.

Regular physical activity can help you lose weight or maintain a healthy weight. Other benefits of physical activity are better sleep, more energy, reduced joint pain, and decreased chances of falling. Physical activity can improve your mood and feelings of well-being.

Types of physical activity include range of motion exercises, stretching, balance activities, strength training, and cardiovascular exercises. Nearly everyone can exercise at some level. Maybe you cannot walk easily because of joint pain, but swimming could be substituted for your cardiovascular activity. Work with your pain management team, physical therapist, or health care provider to find out which physical activities are best for you.

Good nutrition is an important for everyone. Eating a well-balanced diet helps keep your body strong. If you have chronic pain, an unhealthy diet may worsen your health problems and affect your pain level. A healthy diet can help you lose weight or maintain a healthy weight, which can improve pain in weight-bearing joints like your knees. Healthy eating can also help you feel more energetic. Healthy eating is an investment you make in yourself!

Unhealthy eating habits, especially if they started in childhood, can be difficult to change. And chronic pain can make it difficult to shop for food or prepare food. Having to depend on others for these needs can be hard. Talk to your health care provider or a nutritionist about services in your community that can help you overcome these challenges.

Some of the healthiest foods are fruits and vegetables washed and eaten uncooked, whole grains, and lean meats, poultry or fish. Simple preparation of these foods is healthier, and can make it easier for people with chronic pain.

Physical Activity

Good Nutrition

Your health care provider may recommend that you work with a dietician or nutritionist to try to eliminate potential trigger foods from your diet.

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More Pain Management Strategies

Living with chronic pain can be stressful and life-altering. Our emotions and thoughts can play a significant role in how we cope. People with pain may blame themselves for not “getting better,” feel guilty when they are not coping well, and get angry, frustrated, anxious, or depressed when their pain persists. Increased stress can change your pain experience and how you cope with it. Although people can help you learn strategies to cope better, no one can do it for you. It’s up to you to take the first step and keep moving forward.

Stress may be something you have become so used to, it feels normal. Or you may feel weak asking for help to reduce your stress. But coping strategies can give you a sense of control over your pain. Regaining control of your life can help lower your stress, reduce your anxiety or depression, and put you back in charge of your life.

There are many methods used to relieve stress:

Difficulty sleeping is a common problem for people living with chronic pain. And when pain interferes with sleep, chronic pain often gets worse, creating a cycle. You may be able to sleep but not feel rested. Poor sleep can lead to difficulty coping, depression, anxiety, irritability, and daytime fatigue.

An important goal worth achieving is simply getting a good night’s sleep. Not only is the amount of sleep important but also the quality. Deep, uninterrupted, sleep restores you and is necessary for physical and emotional well-being. Adequate sleep allows you to cope better and to take a more active role in managing your pain. Restorative sleep allows you to think more clearly and be more coordinated. Poor quality sleep increases the risk of illness because it affects your immune system. Poor sleep also has negative effects on metabolism and can lead to weight gain.

There are many therapies and medications that can reduce your pain and help you be able to get a good night’s sleep. Talk to your health care provider or pain management team about which of these is right for you.

Social support is one of your most important coping strategies. Living with chronic pain is a personal experience that only you fully understand, but it is important to tell friends and family what you are feeling and how they can help you. Like you, your family and friends may feel angry, anxious, and sad that they can’t control your pain. Chronic pain uses up emotional energy and may make it harder for you to control your moods. This may lead to negative emotions and cause stress between loved ones. A chronic illness can also lead to economic hardship and resentment.

Reaching out to others is one of the most important strategies to help you cope. Some people may be uneasy talking about their pain with others. You may feel like no one really understands or believes you. You may isolate yourself to cope with these feelings. Sometimes pain can make you so tired and sad that you just don’t want to make the effort. But sharing your experiences can help you learn from others the best strategies to try and those to avoid. Support groups and behavioral therapy can help you share with others who have similar problems, gain a better understanding of pain and influencing factors, and learn effective coping skills. Connecting with others who live with chronic pain can strengthen you emotionally and psychologically.

Even if you can’t control the pain completely, you can control how you live the rest of your life. Staying connected to others can help you smile, laugh, and enjoy life.

Stress Reduction

Sleep Strategies

Social Support

Meditation Prayer Deep rhythmic breathing Purposeful muscle relaxation

Things you can do on your own

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Other Things That Can Make Pain Better

There are many different medicines that your doctor can prescribe for your pain, or you may be asked to use medicines that are over-the-counter. Some people worry about becoming addicted to pain medicine. Taking medicine as it is prescribed can lessen that risk. If you are taking any other medicine, including vitamins or herbal products, it is important to let your health care provider know.

Reclaim your life! Decide that pain will not take “center stage.” Let go of unhealthy habits. Celebrate every step as you achieve your goals. Get moving, reduce stress, and get your sleep. Attend a support group to learn better ways to cope with your pain and stay connected with others.

Remember, you are an important member of your pain management team!

Keep pain tracking records so you can communicate what works best for you

Follow your pain management plan

Take medicines as prescribed

Make the lifestyle changes that will help lessen your pain and keep you healthier

Reading Watching TV Playing a game

Complementary Therapies

Heating pads Warm compresses

Working puzzles Doing art work Listening to music

Ice packs

Nerve blocks using regional anesthesia

Trigger-point injections

Chiropractic/osteopathic medicine

Energy therapies such as Healing Touch or Reiki

Acupuncture/ acupressure

Yoga Massage

Invasive Options Surgically implanted

devices Intra-spinal analgesics

Medicine Distraction

Heat and Cold

Questions For You To Ask

Questions To Be Ready to Answer

1) What do you think is causing my pain? 2) Do I need any further diagnostic tests? 3) What treatment approaches do you recommend? 4) For how long will I need to be treated? 5) Are there any restrictions that I need to follow? 6) What other methods can I use besides taking medicine? 7) What self-care measures should I be taking? 8) Will you be referring me to other specialists? 9) Can you please tell me about the medicines you prescribed

for me:

What do they do? When do I take them? How much should I take? How long does it take for the

medicine to start working? If my pain doesn’t go away,

can I take more medicine? What are the side effects? What if I forget to take my

medicine or take it later than I was supposed to?

Should I take my medicine with food?

Is it safe to drink alcohol, drive, or work after I’ve taken the medicine?

Are there medicines or supplements I cannot take with the pain medicines?

What should I call you about right away?

How do I contact someone after hours?

What if I run out of my medicine?

Write down any questions you plan to ask, then bring the list to your appointment. You can use this list as a guide.

1) When did you first begin having pain? 2) How often do you experience your pain? 3) What do you think is causing your pain? 4) Can you describe your pain? Does it radiate? 5) What does your pain prevent you from

performing―daily activities, work, recreation, caring for yourself and others?

6) Do you exercise regularly? 7) Do you experience anxiety, depression,

anger or frustration because of your pain? 8) How is your appetite most of the time? 9) How much stress do you feel most days? 10) How well are you sleeping most of the time? 11) Do you live alone or with others? 12) Do have to climb stairs at home or at work? 13) Do you feel supported by your family, friends

and co-workers? 14) Do you have other health problems such as

diabetes, hypertension, heart disease? 15) Do you smoke or drink? Do you use

recreational drugs? How much and how often? 16) What treatments or self-care things have you

tried so far? Has anything helped? 17) What medicines are you currently taking

(prescription and non-prescription)? 18) Are you employed, unemployed, or disabled? 19) Is your pain related to work? 20) What are your goals for your pain relief? 21) Do you believe you can follow a plan we come

up with together for managing your pain?

Prepare for Your Appointment

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You can use this form to show how the things you are doing to manage your pain are working. You can also use it when you have new problems related to your pain. You may make multiple copies of this form.

The areas where I feel pain are:

My Goals:

(Circle one) 1 2 3 4 5 6 7 8 9 10

When I’m resting, I want to be … When I’m doing this activity: _______________ (Circle one)

1 2 3 4 5 6 7 8 9 10

Pain Free/ Most Comfortable

Most Pain/ Least Comfortable

Pain Management Plan: Current Pain Medicines (prescription AND over-the-counter) 1) ___________________________________ 2) ___________________________________ 3) ___________________________________

4) ___________________________________ 5) ___________________________________ 6) ___________________________________

Other Pain Relief Methods: (like heat, massage, relaxation techniques, etc.) A) __________________________________ B) __________________________________

C) __________________________________ D) __________________________________

Pain Rating Scale ― How I Feel Right Now:

0 1 2 3 4 5 6 7 8 9 10 No Pain

Moderate Pain Worst Possible Pain

I want to be …

Name: ______________________________ Date: ____/_____/______

(Write an “X” on each area) Front

Back

Right Right Left Left

Pain Free/ Most Comfortable

Most Pain/ Least Comfortable

Pain Tracker

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Date: _______________ Name of Medicine: _____________Strength: _____ How Many to Take: _____ How Often: ___________ Possible Side Effects: _______________________ Date Discontinued: ________________________ Reason Discontinued: _______________________ Prescribing Doctor: ________________________ Pharmacy Name: __________________________ Pharmacy Phone: _________________________ Notes: (Take with food?) _____________________ Date: _______________ Name of Medicine: _____________Strength: _____ How Many to Take: _____ How Often: ___________ Possible Side Effects: _______________________ Date Discontinued: ________________________ Reason Discontinued: _______________________ Prescribing Doctor: ________________________ Pharmacy Name: __________________________ Pharmacy Phone: _________________________ Notes: (Take with food?) _____________________ Date: _______________ Name of Medicine: _____________Strength: _____ How Many to Take: _____ How Often: ___________ Possible Side Effects: _______________________ Date Discontinued: ________________________ Reason Discontinued: _______________________ Prescribing Doctor: ________________________ Pharmacy Name: __________________________ Pharmacy Phone: _________________________ Notes: (Take with food?) _____________________

Type of Method: _________________________ Administered by Self or Other? _______________ Purpose: ______________________________ How Often: _____________________________ How Long to Continue: _____________________ Notes: _________________________________ Type of Method: _________________________ Administered by Self or Other? _______________ Purpose: ______________________________ How Often: _____________________________ How Long to Continue: _____________________ Notes: _________________________________ Type of Method: _________________________ Administered by Self or Other? _______________ Purpose: ______________________________ How Often: _____________________________ How Long to Continue: _____________________ Notes: _________________________________

These are samples of forms you can use to keep a history of your pain medicine prescriptions and your methods for relieving pain without medicine. When you keep this information up to date, it can help you communicate with your pain management team at each office visit. It’s also a great idea to keep a log with the names and contact information for each member of your pain management team. Keep this information in your wallet, purse, or pain notebook for easy reference. Please bring your tracking logs and your pain medicines bottles to your doctor visits.

Sample Tracking Logs

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Approximately 100 million adults in the United States experience chronic pain—you are not alone.

What is Pain?

Acute Pain

• Pain is a common life experience. Pain is the body’s way of sending an alert to warn us about potential harm that requires our attention.

• Pain is both physical and emotional. • You are the only person who understands and can describe your pain and

how it impacts your life. • In some people, the body’s pain alert system doesn’t work correctly and

acute pain turns into chronic or persistent pain.

How are Acute and Chronic Pain Different?

Chronic Pain Response to stimuli?

What Can Manage Pain?

A normal reaction to a pain-causing event

An abnormal reaction―there is nothing “normal” about chronic pain

Serves to protect? Yes―to warn that something is wrong

No―but it persists for weeks, months, or years

Is it predictable?

Yes―usually happens suddenly because of an event

No―it’s uncertain how it will progress

Diabetic neuropathy, fibromyalgia, migraine headache, lower back pain, post-herpetic neuralgia (from shingles)

What are some examples?

Trauma, burn, postsurgical, child birth, cancer

Pain medicines are often effective and can be combined with non-drug methods like heat, massage, relaxation

What’s the pain management plan?

Pain medicines may or may not provide relief―multiple approaches may be used

A varied approach to improve function, ability to cope and integrate healthy lifestyle strategies to manage the impact of pain on daily life activities

What’s the goal? Pain management and preventing the changing of acute pain into chronic pain

• Increase physical activity, strength and flexibility

• Eat a healthy diet • Make sure to get enough sleep

The good news is there are many factors we can

manage and change including:

• Reduce stress • Take steps to improve coping

methods • Build a network of strong social

support

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Managing Pain: What You Need To Know

Get moving.

Action Plan for Managing Pain

Check off items from the list below that you will be able to change or improve. Or you can write in your own action items.

Take an active role. Here are some things you can do:

Follow what you and your team agree to do to manage your pain. Keep a record of your pain so you can communicate the day-to-day changes in your pain. Take all medicines as prescribed.

Connect with others living with chronic pain.

See the whole picture. Decide that pain will not take “center stage” in your life. Give yourself the power to dull the noise of pain―reclaim your life.

Identify things that are most important in your life and set realistic goals you can accomplish.

Celebrate every step you move forward toward your goals.

Get moving even if you fear exercise will cause you to hurt more.

Prioritize your activities to ensure you have energy and stamina for important activities you want to accomplish.

Let go of unhealthy habits.

Make sure to get enough sleep.

Take steps to reduce stress. Improve your support system.

Other

Set realistic goals.

NPC631902-01 ©2014 Pfizer Inc. All rights reserved. Printed in USA/January 2014

1. Are the items that you have chosen achievable?

2. What will you do to make these changes? _______________________________________________

_____________________________________________________________________________________________

3. When will you make these changes? ____________________________________________________ ______________________________________________________________________________________________

Yes No

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