Pain is the most common symptom which brings a patient to the hospital. Yet, pain is mostly misunderstood, inadequately studies and grossly neglected as a whole. A lot of myths about pain and pain medications have clouded the facts about the same. Some Myths and Facts, in simple layman’s language will hopefully give some clarity on the issue.
Myth 1: Pain is inevitable; nothing can be done about it.
Fact: It’s not necessary that you will experience pain in your medical condition. However, even if you do, there is a lot that can be done to keep you comfortable. No matter what your diagnosis or stage of illness, there are many medicines & non medicine management that we offer to control pain.
Myth 2: If you ignore your pain, it will go away
Fact: Pain happens when there is an injury or some harmful changes in the body. This sensation from the affected part is carried by the nerves from the problem area and transmitted to the spine and thence to the brain where pain is perceived. If this pain transmission is allowed to continue, the “sleeping” nerves near to the problem area also wake up and start getting excited because of the pain nearby. Then these woken up nerves also start transmitting pain sensation even if there is no direct injury or problem in the new area. This process is similar to what happens in a kindergarten class, where during the sleep period if one child is naughty or not sleeping, this slowly disturbs the nearby children who also skip sleeping and become naughty and soon the whole class is no longer sleeping but making a lot of noise. Similarly, if pain is allowed to continue for long, the patient starts experiencing increasing intensity of pain and spreading of pain to more parts of the body with passage of time. (Medically the phenomenon is called Sensitization & Recruitment). People who have been experiencing pain for a long time are usually very quiet and laying still on bed. Many think they have adapted to their pain. This is not the case. The fact is patient who have been experiencing pain for a long time are so exhausted by it that they no longer have any energy to cry and shout.
Myth 3: Tolerating pain is better than taking pain killers
Fact: Pain produces stress and release of stress hormones in the body. Prolonged exposure to stress hormones (due to continued pain) is harmful to the body. It causes fatigue, weakness, and decreased immunity, decreased appetite, decreased sleep, all of which in turn produce more weakness. Somebody in pain would also be less active, mostly sitting or lying down. Decreased activity weakens the muscles and bones which in turn produce more muscle & bone pains and further weakness. Many patients become bedridden just because of inadequate management of pain and this in turn leads to development of bed sores, stiffness in limbs, poor hygiene and frequent respiratory and urinary infection. Patients who become bedridden due to pain have similar poor quality of life like other patients bedridden with incurable medical conditions. Prolonged Pain also adversely affects the mind. Pain if allowed to prolong can produce depression. People who have been experiencing pain over a long duration sometimes loose all motivation, loose ability to enjoy simple pleasure of life (like enjoying music or social interaction), become suicidal and lose their spirit to live. Hence we need to understand that tolerating pain is harmful to our body and mind. It can decrease our quality and sometimes quantity of life. It can also affect our spirit and motivation to live a meaningful and productive life.
Myth 4: Pain killers are harmful and hence should be avoided.
Fact: We do not use words like “Sugar Killer” or “Pressure Killer” for medicines that control high blood sugar or blood pressure. Hence to call pain control medicine as “Pain Killers” itself shows our inherent negative attitude towards it. No medicines should be taken without any reason or supervision. However if you have a medical problem, then not taking medication can be harmful. You may have realized by now that not controlling pain is harmful to our body, mind and spirit. Hence we should take “Pain Medicine” to live a happy, meaningful and productive life. Needless to say, Pain medicines (like any other medicine) should be taken under the supervision of a doctor only (if possible, a Pain Specialist), for safe and effective pain management.
Myth 5: Pain medicines should be taken only when pain is severe or unbearable.
Fact: You may have realized by now that ignoring pain only increases the problem (as the intensity & area of pain increases by a process of sensitization & recruitment). Hence like blood sugar or blood pressure management, pain should also be controlled 24hrs a day, all days. Pain is an abnormality and has no place in a normal human everyday life. To achieve good pain control 24hours a day, all days, we have to keep the blood levels of the pain medication steady, for this we have to take the next medication before the effect of the previous dose goes away. It is like a relay race where a pain medicine works for a fixed no. of hours, then the next dose takes over, if there is a gap between the doses (due to delay in taking/ or forgetting to take) then the pain control is broken and pain can increase to previous levels, then it may take a lot of effort, time & needless suffering to bring it back under control. If you feel that your pain has decreased and would like to reduce and if possible stop your pain medication, then please visit your doctor (if possible the Pain Specialist), who will gradually bring down the dosage in a controlled and scientific manner. This will help in avoiding problem associated with sudden unscientific withdrawal of medication.
Myth 6: Morphine is given to dying patients, to sedate them. It causes addiction. It’s a dangerous medicine.
Fact: Morphine is gold standard pain medicine used all over the world, to get relief from pain, irrespective of disease or stage of illness. It is a natural, plant product (purified from opium), primarily used for control of pain, but also used in some circumstances to control breathlessness and cough not controlled by other medicines. When used for pain in curable illnesses, it can be gradually stopped. However when used for pain, in incurable illnesses, it may have to be continued to sustain good relief. When used in optimum doses, morphine does not produce sedation. In fact, once the distressing pain is relived with morphine, people get energetic and become active (if there is no other pre-existing impediment to being active). There are many people on regular morphine therapy, leading active and productive lives. Morphine is not a panacea for all types of pains. In many pains, morphine alone may be sufficient, but in some pains, you may have to take other pain medicines along with morphine for satisfactory pain control. In miniscule number of pains, morphine may not be effective at all and other pain management techniques may be needed to achieve good pain control. Morphine is repeated every 4 hours as the clinical efficacy lasts only that much before it is eliminated from the body by the kidneys through urine. The frequency is adjusted only if there is any preexisting impairment of kidney. Morphine does not cause gastric ulcers or kidney or liver problems, hence very safe to use. Actually it is so safe that it’s the only analgesic that can be used for somebody on dialysis due to kidney failure.
The chances of addiction with oral morphine though theoretically possible, for practical purposes it’s hardly to be seen. The usual side effects of regular oral morphine therapy are constipation which can sometimes pose quite a challenge and may require large doses of laxatives. Other side effects are nausea and sleepiness which usually are self limiting and wear off by about a week of starting morphine therapy. Some people may report itching, which again can be easily managed. Toxic effects of morphine appear ONLY if one accidentally or deliberately consume more than ones clinical requirement. The toxic effects that you should be on the lookout for are,
- Drowsiness (not to be confused with sleepiness where the person can be easily aroused).
- Myo-clonus (short jerky movements).
- Delirium (abnormal behavior or speech, sometimes accompanied by hallucinations).
- Nightmares (frightening dreams).
- Deliberate overdosing despite seeing the above mentioned early signs may lead to respiratory depression and if neglected even death.
If any of the toxic signs & symptoms is seen, STOP morphine and bring the patient to the hospital. Oral morphine is a government controlled medicine and NOT available in medical shops or hospitals. It will be dispensed to you ONLY through your Pain & Palliative Medicine Specialist. Hence keep track of the stock in your hand and get new stock before your present stock gets over. Since it’s a natural, plant product, it is advisable to keep oral morphine in an airtight container. Needless to say, oral morphine is to be taken strictly as per advice of your Pain & Palliative Medicine Specialist only, self medication is likely to be dangerous. Keep out of the reach of children and other vulnerable individuals. Most importantly, give morphine to the patient in pain; strictly as advised, and especially on time.
(The article is authored by Dr. Biju Raghavan, Pain and Palliative Medicine Specialist, KIMS Hospital Trivandrum.)