"Pain is inevitable; suffering is optional."

Saw a question about Pain, And thought I’d Re-Post----- (PLEASE SKIP it if you’ve seen it) --------------------------------- Pain Meds- I was asked recently by a Pre-Op – “What was the pain like?” I was very quick to respond That it wasn’t so bad really, And the Drugs were Great! This was awfully Flip and Glib of me, And after giving it some more thought, I had thought of a wealth of info That I wished I had passed on. So, Some babble about Pain Meds while at the hospital- Expect the best. If you're in pain, ask for more drugs, Or a change of Medication. Tell the Dr. exactly how you feel. If the Dr. won't be around for awhile, Tell them to give him a call. And They Will! Successful Pain management should be just that! Most important- You will need to be able to describe your pain On the universal rating of- “On a scale of 1 to 10, 1 being no pain, And 10 being absolutely unbearable, How would you rate your pain?” (Here's the "Scale" that is used most often) Do not be deceived. If you speak in terms of Extreme Discomfort, or “Very Un-comfortable,” That has no place on the nurses’ or Dr.’s radar. Speak in PAIN (1 to 10) Lingo, And something will be done. Also be able to specify the type of pain- Is it- "Stabbing? Dull? Aching? Burning? Crushing? Pulsing? Throbbing? etc... Specic types of pains indicate different causes. The Pain Management team can serve you better with Better info. Do be Completely Honest, But don’t lie there felling terrible Because it’s “Not time for your pain meds again yet.” That just means that they are not adequate to do the job, And should be adjusted.

"Pain is inevitable; suffering is optional."

The Nurse can not adjust the level, frequency or type Of pain management. Only your Dr. can do this, So let him or her know ASAP while they are there. If the Pain Medication you are receiving Is making you nauseous Tell the Nurse, and ask her to contact the Dr. To ask for a Drug that does not make you nauseous. For Example- If you have a problem with the Morphine Making you Nauseous, Tell them to try something else. Demerol, Or a Demerol/Phenagrin Mix. It’s your care. They’re getting paid, So they are working for your well being. And keeping your pain at a “managed level” Is part of that care. Have someone with you who can Be your advocate. (Most Important!) You should be comfortable, calm and Get the rest you need to heal. We have the technology! Your Nurse, if like most nurses, Will be stretched very thin Looking after more patients than They should be asked to serve. Hospital Administration is fighting to Keep the overall “bottom-line” in the Black, And it is the Nurses that are carrying Most of that burden Be understanding, yet, Don’t accept the- “Do you want your pain medication or Not? Because This is all I can Do!” Your Key to Getting the attention of your Health Care providers, when it comes to Pain Is the simple Phrase- “This Level of Pain is Unacceptable / Un-Bearable And something must be done. Would you please put a call into my Dr.? Or get me a CONSULT?” In the Very Litigious Society we live in Every Hospital knows that failure to provide “A Consult,” In an area of expertise outside or beyond The expertise of your Dr., Opens them to future Liability Should something go wrong. I’m not saying be a bully and a horrible patient, But know that you will only get results if you Know how to ask the right questions. I’ve had 8 fairly Major Surgeries In the last Two Years and have amassed A good bit of Anecdotal information. Some of this is just from comments from multiple Nurses, Some is from a touch of web research. Look it up for yourself and be informed Before you head in to the Hospital. So, if your pain is coming on up And part of your discomfort is from Gas and constipation, The Dr. will explain to you that Pain Medications Cause more constipation and Gas. This is Very True of Morphine and Demerol. However, Nubaine, which is just as effective Does not typically have this side effect, Nor do most of the Synthetic Opioids. Morphine tends to cause a number of people to itch. If this is the case with you and the itching is causing You to lose rest, ask the Dr. if he could put Benedryl on your list of medicines on an “As Needed Basis.” Not only will it make the itching go away, It increases the effect of the Morphine’s Sedation properties. The Most used IV Pain Med, early on is Morphine. It is the “Go To Drug” because it does its job well. One of it’s draw backs, if you have to have it For 5 days or more, is that it is Very Addictive. One can also build up a tolerance to it And it’s effectiveness decreases over time. I have had Morphine on a self administering pump And as an IV injection every 4 hours. The IV injection was far more effective for me than the More frequent lower doses. Morphine also has side effects When interacting with most Anti-Depressants. It’s noticeable side effects for the average patient include- Nausea, Itching, Increased Constipation. It also aggravates Urine retention. If this is the case with you, Ask for a substitute. Sustained use will also contribute greatly to Temporary Dementia. In combination with the constantly interrupted sleeping schedule The result is common “ICU Psychosis.” Hallucinations that would leave Timothy Leary in the Dust! Demerol is the second most popularly used IV Pain Medication. It also is rather addictive, but not quite as bad as Morphine. It tends to give many patients a feeling of “Floating” or “Bed-spins” That lead quickly to nausea. For this reason it is often Given with Phenagrin. When paired with Phenagrin it is very sedative and Will put the patient to sleep usually. Demerol, like Morphine also can cause constipation, Just not as bad as Morphine. It doesn’t have the reputation for causing patients to itch, However, that is listed as one of it’s side effects. It also lists the same drug interaction problems as Morphine. I have been given Demerol to slowly replace Morphine When its effectiveness was reduced by my increased tolerance. The Demerol / Phenagrin “****tail” was very effective In keeping pain to a minimum while not giving me nausea. As with the Morphine, I found the direct IV injections to Be the most effective. I have also been given Valium IV a couple of times, But this was during procedures in radiology were they Were setting a drain. It’s mostly an extreme sedative - anti-anxiety drug but When used in conjuncture with pain killers and local anesthesia It’s great. So is SUBLIMAZE® (or Fentanyl Citrate) It has an odd “out of body” sensation that’s very pleasant And similar to AQUAVAN® (which is also very soothing) (told ya I’d had my share of the Drugs!) Nubaine would be my IV drug of choice. The Pro’s and Cons of Nubaine are- It is No Where Near as addictive as Morphine and Demoral, But, it seems to have little to no effect on about 20% of people And therefore is not a completely reliable Pain Management tool. It also doesn’t increase incidence of constipation, Therefore if your pain is predominantly Being caused by extreme gas, it is very effective In “breaking the loop” of more pain meds causing more pain. So, If you are having pain and the Dr. is not wanting to Give you a higher dose of Morphine or Demerol due to It’s ill effects on the digestive tract. Ask about Nubain. It has a much lower incidence of nausea, dizziness, vertigo, etc… And is very effective when you are not in EXCRUSIATING PAIN. Now all of this is not to suggest that you second-guess your Dr. at all, BUT, do be very open and frank with him or her. Pain management is however, just that. Management. They Cannot get rid of it completely. And it is better to take something for it Before it becomes intolerable. But because pain is such a subjective aspect of surgery And one that you are the authority on, The system tends to err on the side of not “Over Doping” the patients And will, if allowed, sometimes treat your complaints as Less than objective, driven by the knowledge of the Addictive powers of most drugs. Full and open communication from you or from your Advocate or loved one is the best way to insure that You will have a fairly pain-free time of recovery. There are many benefits of pain relief .... You are much more likely to walk, Cough and deep breathe effectively if you are not in pain. You get no points or benefits for suffering.... As a matter of fact, it will slow your recovery considerably. Another hint, if you are awake, Try to change position in bed every two hours after surgery.... If you have had surgery you already know how difficult this can be, Yet it is a very effective tool in speeding recovery And preventing pneumonia and atelectasis (lungs not breathing deep enough). Expect the Best, and ask for it if you’re not getting it. Once you have gotten past the first couple of days Or even after the first day for many, You may be moved onto oral pain management. You certainly will before you are allowed to go home. Lortab Elixir is very common for Gastric Bypass patients. It is during this transition from the “Big Guns” Of IV pain meds, To the “Kinder, Gentler” oral pain meds, That many people experience MOST of their pain. It’s that transition from “too much,” To- “not quite enough,” that is tricky. Know that if you have moved off of the IV’s You are on your way to merely discomfort Rather than Pain, and it’s soon to pass. The Lortab elixir and the 2^nd most popular- Vicodin, as well as Hydrocodone, All increase your gassiness and constipation, So use them sparingly. Once you are home, Walking is one of the best Long range pain management tools and Since most of the pain will be from “trapped gas,” The Walking targets the problem rather well. Once home, also try a simple Heating pad.  Place it on your back and not on your Actual incisional area. The comfort from the heating pad comes from increasing your Blood flow in the area where applied, And increasing blood flow to your incisional area Could increase your odds of having a Seroma. (Blood or Fluid Trapped within tissue.) Another great pain reliever is a loved one willing To rub your hands or your scalp. Any such stimulation releases endorphins and causes You to just “feel better.” This long of a post surely makes up for my Glib- “Not so bad, and the Drugs are great!” Any of you out there with pain med info- Please add on to this post. Best Wishes- Dx

Hey Dex - Love the title of this post (and, great info as always)....... I always laugh when i see the pain scale, because it always reminds me of when my 81 year old Dad was in the hospital with some major complications to his cancer.  The nurses and physical therapists would come in with that pain scale (with the little faces) and he thought it was the most ridiculous thing he'd ever seen (yea - he's a stubborn SOB just like me.........).   So, I'd explain to him why it was important, and to look past the fact that it was "childish" drawings (as he put it)... Anyway - had to share that.  To this day I can't see that pain scale without smiling and thinking of my dad getting pissed cuz he thought it was so condescending to show him those little faces LOL..... Take care, and thanks again for all the informative posts you do.

Ah, Dx-san, how very Zen of you!  All very good  advice, and it's good to see it reposted. My hospital uses IV hydromorphone (Dilaudid) as its usual alternative to IV morphine. I recall waking up in the Recovery Room after the RNY, asking for pain meds, and even though I was still in a post-anesthesia haze, the morphine gave me a whopper of a stomach ache (cramps, spasm).  So, for the remainder of my inpatient stay they switched to hydromorphone.   No cramps, and just as effective.  (Of course, it still constipates you, like almost every opiate drug.) I suspect that if I'd asked for Nubain (nalbuphine), 90% of the staff would have said "What?"  The other 10% would have given me a urine drug screen before I got another pain med from them!    As you report, it has a reputation for causing inconsistent pain relief, but it always worked well for me.  There was a factoid reported 10 years or so ago by researchers at UCSF that nalbuphine and its agonist/antagonist cousins seem to relieve pain better in women than in men.  (Maybe it works better in gay guys?   ) Right now, I'm 2 months away from getting a hip replacement (I was bone-on-bone by the time of my RNY), and I'm eating Percocet like Skittles, just so I can continue my daily exercise to ensure that I keep dropping the weight! /Steve