Managing pain with medication in youth - Canuck Place Children's Hospice

managing pain with medication – Youth Version

This fact sheet will help you and your family learn about managing pain with medication for youth and using medicines (including opioids) for relieving pain. Knowing the facts will help you manage your pain with the goal of being able to continue your daily activities with less pain.

What is pain?

Pain is an unpleasant sensation, suffering or distress. Pain can make you irritable, make it hard to sleep, reduce your appetite, and make it hard to be active, participate in your usual activities and enjoy life. Everyone can experience pain differently and it can change from day to day or with certain activities or even emotions (especially when you try to hold those emotions in!)

It is important to know that most pain can be relieved!

Types of pain

It can be helpful to understand different “types” of pain. Although you may be experiencing more than one type, it may help you to better describe it to your care team. Different medications work better on different types of pain and we want to do our best to ensure the medication prescribed will provide pain relief.

Acute pain is short-term pain. It comes on quickly, lasts a relatively short time and can range from mild to severe. It is caused by tissue damage or inflammation. Chronic pain is long-term pain. It may last a few weeks or months or be ongoing. It may be constant or come and go, and it can range from mild to severe. Chronic pain can start as acute pain and then stay beyond the normal expected healing time. It is also called persistent pain. Pain can also be described based on the part of the body it affects. Nerve pain is caused by pressure on the nerves or spinal cord, or by damage to nerves. It may feel like burning or tingling. Bone pain is caused by damage to a bone and it may occur in one or more areas of bone. Bone pain is often aching, dull or throbbing. Soft tissue pain is caused by damage to an organ or muscle. It is usually sharp, aching or throbbing. Visceral pain is pain that starts in internal organs such as the intestine or bowel. It is often difficult to describe or find the source of the pain. It is often linked with other symptoms such as nausea and sweating. Phantom pain is pain or changes in sensation in a body part that has been removed. For example, some people feel pain in an arm or leg that has been amputated. Referred pain is when one part of the body causes pain in another part. For example, a swollen liver can press on nerves and cause pain in the right shoulder.

How can I tell you about my pain?

At Canuck Place, our team works hard to understand your pain. We can use tools, such as the faces scale or number scale to see how you rate your pain. You may also have your own way of describing and rating your pain. We will work with you and your family so we can best understand and treat your specific pain.

Managing pain in youth

We have an amazing team to help manage your pain, but the most important team member is you! Our team of specialized doctors, nurse practitioners and nurses will work with you to choose the medicine to best manage your pain. Sometimes it may take one medicine or a combination of medicines to best manage the pain – it can be a balancing act and we may need to try different medicines! We like to start off with low doses and slow increases in order to see how your body responds to the medicine and watch for any side effects. We may also suggest some medicine-free ways to reduce pain such as heat/cold, massage, counselling and/or mindfulness.

Our team is available 24/7 to answer questions and help to manage your pain!

Communicating with your team

Your “team” includes yourself, your family, caregivers and medical professionals involved in your care. Sharing information with team members and being open and honest about your pain will help to provide better pain management.

It is very important to listen to your body and your pain. Have you ever found yourself thinking or saying any of these things?

I can get through it – I don’t need any medication
I’ll just wait a bit and see if the pain goes away
I’m scared to take the medicine
I’m scared I will become addicted

You do not have to try and live your life through the pain – you will have more enjoyment in your activities when your pain is under control. It is important to remember that when pain is left for too long, it can quickly get out of control and become harder to relieve and manage.

Sometimes taking an opioid can feel scary – especially if you have heard negative things on social media or if one of your family or friends has a strong opinion about it. Remember that the medication has been prescribed by a specialized doctor or nurse practitioner who has given you a safe dose to effectively manage your pain. Your team will also be with you and will check in – you will not be alone!

When you take the medication as prescribed, you will not become addicted. Your body needs the medication to block the pain receptors that are signaling your brain to tell you that there is pain. Your treatment will be reassessed and your dose can be adjusted depending on how your body responds. For example, if you receive a treatment that reduces your overall pain, then we may slowly reduce your pain medication if your body doesn’t need as much medicine to manage your pain. Our team is always willing to talk with family or friends if they have questions or concerns.

Tell your Doctor/Nurse Practitioner about all your medications

It is very important to tell us about all the medications you take. This includes any over the counter medicines (like ibuprofen, acetaminophen, allergy pill etc…), herbal products (including THC/CBD), and health supplements. This helps to make sure you are not prescribed a medication that you are already taking or one that interacts with your current medications.

Ask Questions when you have them. There is no such thing as a stupid question!

Here are some helpful questions to think about when you communicate your pain to your team

What activities or movements can bring on the pain?
Where is your pain?
How intense is your pain? Does it radiate to anywhere else in your body?
What does the pain feel like? For example: is it sharp, dull, and/or aching?
What makes the pain better or worse?
If you are using pain medication, how much does it relieve the pain?

Sometimes writing the answers down or having a family member write them down is helpful for remembering when you speak with your team. The more you can tell us about your pain, the better we can try and manage it. We can give you some tools to keep track of your pain and what treatments or medicines work to relieve it. This will help us to make adjustments to your pain management plan.

Choosing the most appropriate medication when managing pain

When your doctor or nurse practitioner is choosing the medicine or combination of medicines, they will base it off the type, intensity (how strong) and frequency (how often) of your pain. It can take some time to get the right medication or right balance of medications for adequate pain management. Again, this is why it is so important to communicate your pain with your team!

When you first start a medication you might feel drowsy or tired – this can be normal. It is important that you tell us how the medication makes you feel and if it is working. We usually ask that you give the medication a few days to see how your body will react to the medication. If your pain has been really intense prior to starting the medication, it may take a little longer to begin to feel relief.

Types of pain medication

Mild pain relievers, such as anti-inflammatories and acetaminophen
Medium to strong pain relievers, such as opioid medications
“Helper” medications or adjuvant medication

Facts about Morphine and other Opioid medications

Opioid medicines are pain relievers that have been used for many years. At Canuck Place, our doctors and nurse practitioners frequently prescribe: morphine, hydromorphone, methadone and fentanyl. Some of the differences of these medicines include:

Onset of action (length of time to start working)
Immediate
Delayed
Duration of action (length of time they last)
Short acting (for a short time) – these would be used for “incidental pain” like bathing or position changes.
Long – acting (for a long time) – some opioids are designed to be released slowly and can last for 12-24 hours.
Administration (how they are taken)
By mouth (tablet, capsule, liquid)
By injection into the fatty tissue in the skin, intravenously or (rarely) a muscle.
By a patch placed on the skin that is changed every 2-3 days.

Possible side effects

These will be reviewed with you based on the medicine/s prescribed for you. One side effect that is common amongst opioids is constipation. You will be asked to track your bowel movements (frequency, consistency) and we will add a stool softener or laxative if it becomes problematic.

**Opioids may also be prescribed for other symptoms, such as dyspnea (difficulty breathing) or coughing. They work to increase vasodilation in the lungs (increasing the amount of oxygen that goes into your blood stream) and relax the muscles that can feel tight.

Adjuvant medications

Steroids (dexamethasone). These are strong anti-inflammatory medicines that may help relieve pain by decreasing inflammation. They may be used along with other pain relievers for nerve, bone, or other types of pain. It is usually used for a short amount of time only.
Antidepressants. Treating any existing depression or anxiety can make pain easier to control. These drugs may also be useful in pain caused by nerve damage.
Anticonvulsants. These medicines are usually used to control seizures, but they can also help control nerve-related pain.
Local anesthetics. These are medicines that can block pain signals in the body. A pain specialist may inject a local anesthetic to block pain.
Muscle relaxants. Antianxiety medicines and muscle relaxants may be used along with pain medicine if pain is aggravated by tension or muscle spasms.
Bisphosphonates. These medicines are sometimes used to prevent fractures in people whose cancer has spread to the bone. They can play a key role in relieving bone injury and pain.

Cannabinoids

Medical cannabis (THC, CBD or combination) may also be considered for pain management. Very little research exists on medical cannabis and its use in children and youth. Canuck Place doctors and nurses will work with your health care specialists to prescribe medical cannabis for symptoms in which medical cannabis may have the best impact for you. Canuck Place has a separate in-depth information sheet on the use of medical cannabis which you can request to learn more and decide if this may be a consideration for you.

Using your medication the right way when managing pain

It may feel overwhelming at first to learn when to take your pain medication and if you have a combination of medications, which one to take. Our team will do our best by giving you specific instructions for which pain medication to take and when. Your medication may be prescribed as “regular” or “as needed” – it is important that you understand the difference. If you ever have any questions, you can contact a nurse by calling the Kids Counter 24/7.

Regular or daily medications

Take your medication regularly at the intervals prescribed (or as close as possible to those times) to get the maximum benefit. If you delay the medicine for too long, you may experience avoidable pain and it may be harder to get your pain back to your baseline once it flares up. If you take the medication too soon, it could make you drowsier or affect your breathing. Setting a timer on your phone or watch is a great way to remind you when it is time to take your medication. If you forget to take a dose or have questions, you can call the Kids Counter 24/7.

As needed or PRN Medications.

These medications are to be taken if you are having increased pain or when you will be doing an activity that you know will cause you pain. Sometimes you will be prescribed a “PRN” (as needed) pain medication in addition to a “regular” pain medication. It is important to keep track of how often you require the “PRN” medication as it may indicate that we need to increase or change the “regular” medication. Please call the Kids Counter 24/7 if you are requiring more PRN medications to alleviate your pain, especially if you feel they are not working.

Be Organized with your Medications

Keep your medication in the same place so that you always know where it is.
Keep your medication in the original prescription bottle so that you do not mix up the medications or strengths of the medications.
Keep track of how much medication is left in the bottle – when you notice you have less than 3-5 days left, let us know so that it can be refilled. Sometimes it can take a couple of days for the pharmacy to stock the medication, so do not leave it to the last doses.
Return any medications that you are no longer using to the pharmacy for safe disposal.