This blog will help you manage your pain when you go home from hospital after an injury, operation, or painful medical problem. It is NOT a guide for managing more complicated chronic (ongoing) pain.
Some discomfort and pain after surgery or injury is expected. You may still feel some discomfort despite taking pain relieving medicine. It is important to control your pain as you will get better faster if you are active and able move around.
Your pain will decrease as your body heals. However, if your pain gets a lot worse, persists for more than a week or cannot be controlled with pain relievers, or if you have pain that is burning, shooting, or sensitive to just a light touch such as clothing or a sheet, you should see your doctor.
FIRST ASSESS - Is my pain: mild, moderate, or severe?
Mild Pain: I am comfortable at rest and only get slight pain with activity. I can sleep, shower, drive*, walk or work.
Moderate Pain: I am often uncomfortable and have pain with normal activities or when resting. I have difficulty showering, driving*, walking long distances, working, and getting to sleep due to pain.
Severe Pain: I have pain almost all the time. Pain prevents my normal activities, so I cannot shower, walk short distances, leave the house, drive*,
or work. It wakes me at night and stops me from sleeping.
* You SHOULD NOT DRIVE or operate machinery if you have just started taking opioid medications, or changed your opioid medication or dosage, within the last few weeks.
THEN CONSIDER - What medicines to take to help with the pain
Using a combination of medicines for pain is generally more effective than using large doses of a single medicine.
You may be asked to take some medicines regularly for the first week or so after discharge from hospital, even if you don’t feel like you need them. It is easier to control pain by taking pain relievers regularly than to stop the pain once it has built up.
Paracetamol and ibuprofen can be bought over the counter without a prescription. Any of the stronger medications mentioned need prescriptions. It is unusual to need further supply of your strong pain relievers, as pain should settle after discharge from the hospital.
Other ways to help manage your pain (non-medicine strategies)
Gentle physical activities like walking and deep breathing exercises
Ensuring a comfortable and well supported position in bed
Acupuncture, massage, transcutaneous electrical nerve stimulation (TENS), hot or cold packs.
Praying, relaxation or meditation.
Distractions, like watching TV, listening to music, or talking to people.
Information on medicines used to manage pain
If you have been prescribed medicines as part of your pain management, keep in mind the ultimate goal is usually to reduce your pain and improve your day to day living. It’s also important to realise that taking medicines is only one way of managing your pain, and that they are unlikely to take away your pain completely.
Always follow the directions and dosing on the label or box of the medicine you are taking.
Paracetamol has been used in Australia for the relief of pain and fever since the 1950s. It is available in many different forms for adults and children. Common brand names include Panadol, Herron Paracetamol, Panamax, Chemists’ Own and Dymadon. Most pharmacy chains and supermarkets also have their own ‘house brands’.
NPS medicines wise
Paracetamol is safe and effective when taken as directed on the label. However, if taken either in overdose or in amounts that exceed the recommended dose for more than a few days, the unwanted effects can be severe. If an overdose is taken, ring the Poisons Information Centre (131 126) or go to a hospital straight away.
Many other medicines also contain paracetamol including medicines for coughs and colds, sinus congestion and period pain. The presence of paracetamol is always declared on the label. Be careful not to take more than one medicine containing paracetamol.
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and inflammation (swelling and redness). Some commonly used NSAIDs include aspirin (Disprin), ibuprofen (Nurofen), naproxen (Naprosyn), diclofenac (Voltaren) and celecoxib (Celebrex).
While NSAIDs are effective in relieving pain, fever, and inflammation, they can cause unwanted side effects. Gastrointestinal side effects such as indigestion, stomach upset (including nausea or feeling sick) or stomach pain are commonly caused by NSAIDs. Use of NSAIDs can also cause ulcers and bleeding in the stomach and other parts of the gastrointestinal tract (gut).
Stop taking your NSAID and seek advice from your doctor immediately if you develop:
dark, coffee-coloured vomit.
Taking paracetamol before a NSAID and staying well-hydrated can reduce these adverse effects. When you’re taking an NSAID, always use it for the shortest time possible and at the lowest effective dose. These medicines should not be used long-term.
For severe pain, a group of medicines called opioids may be prescribed short-term following surgery or an injury. This includes oxycodone, (Endone® or OxyNorm®) or other medications with similar actions such as tramadol (Tramal®), tapentadol (Palexia®) and buprenorphine (Temgesic®) may also be used.
Sometimes, you may be prescribed a slow-release opioid to take regularly for a limited time only. Examples include Targin® and Palexia SR® or Norspan® patches. The hospital will usually supply you with a set quantity of these medicines and it is unusual to need further supply. If you still have severe pain after a week, see your doctor.
Opioids are best used together with paracetamol and/or an anti-inflammatory. In time, you will only need paracetamol and/or an anti-inflammatory or nothing at all. You should aim to stop using your opioid as soon as you can manage without it and take it for no longer than a week.
You may have some side effects from your opioid medicine. If you are worried about any side effects that you develop or cannot manage, talk to your doctor or pharmacist. Common side effects include:
Drowsiness. Opioids can make you sleepy. It is important that you do not drive, ride a bike, or operate machinery, including power tools whilst taking an opioid medicine. If you become drowsy or sleepy after taking an opioid, do not take any more until you are wide awake.
Nausea or vomiting.
Constipation. Keep up your fluid and fibre intake and stay active where possible. You may need a laxative. If constipation becomes a problem, discuss it with your doctor or pharmacist.
Opioid medicines can also have some serious long-term side effects, including:
becoming tolerant to the medicine — needing higher doses to get the same result, which can result in a lethal overdose
becoming dependent on opioids — experiencing withdrawal symptoms or cravings for opioids if you stop taking them becoming more sensitive to pain
becoming more sensitive to pain
However, the risk of this occurring is low when these medicines are used short-term. It is important to keep reassessing your pain and discomfort regularly to evaluate your ongoing need for these medicines.
Stop taking your opioid if you are feeling very sleepy, having trouble staying awake or are experiencing trouble breathing. Go to the emergency department of your nearest hospital or call emergency services (000).
These medicines should only be taken by you on medical advice. Do not give any of these medicines to relatives or friends, even if they have the same symptoms. Store pain medications in original containers and out of reach of children. Once you no longer require the medicines, take any leftover medicines to your local pharmacy for disposal.