Patient education: Managing acute pain at home (The Basics)

What is acute pain? — 

This means pain that lasts for a short period of time. For example, it can happen after an injury, surgery, or medical or dental procedure. It can be mild, moderate, or severe.

Acute pain is different from chronic pain. "Chronic" means pain that lasts longer than a few months. It can be related to many different long-term conditions, like arthritis, back pain, cancer, or nerve pain from diabetes. Chronic pain is managed differently.

How is acute pain treated? — 

The goal of treatment is to get your pain to a manageable level. It is not always possible to make pain go away completely.

Your doctor will work with you to make a plan for treating your pain at home. This will depend on the cause of your pain and how severe it is, as well as your individual situation.

There are different ways to manage pain. Doctors often use more than 1 of these at a time. They include:

●Non-medicine techniques – For example, it might help to put ice or heat on the painful part of your body. Resting and keeping the painful part elevated can also help. Some people use relaxation exercises or meditation to help them manage pain.

●Non-opioid pain medicine – These include:

•NSAIDs such as ibuprofen (sample brand names: Advil, Motrin) or naproxen (sample brand name: Aleve)

•Acetaminophen, also called paracetamol (sample brand name: Tylenol)

•A "topical" medicine you put on the painful area, such as diclofenac or lidocaine gel or patch

Doctors often recommend taking both an NSAID and acetaminophen on a regular schedule. This can help better control pain. Talk to your doctor about what medicines you should take and how much. People with some medical conditions should not take NSAIDs.

●Local anesthetics – These are medicines that numb the painful part of the body. A "nerve block" is when the medicine is injected near certain nerves, which reduces pain in the area. Sometimes, the medicine is given as just 1 shot. Other times, it is given continuously through a small tube called a "catheter." The catheter attaches to a pump that can continue to give medicine after going home from the hospital.

●Opioids – This is a group of powerful prescription medicines used for severe pain. Examples used at home include oxycodone, hydrocodone, and tramadol. These are sometimes used when other types of pain medicine do not help enough. But they come with risks. For this reason, doctors often try other ways of treating pain first.

What should I know about opioids? — 

If your doctor prescribes opioids for pain, there are some important things to know:

●Opioids have side effects. Some are mild and can be prevented or treated, for example:

•Constipation – Your doctor or nurse might suggest you take a laxative to prevent or treat constipation. If your bowel movements are hard and dry, a stool softener might help. Drink plenty of water.

•Mild nausea or stomach discomfort – Taking the medicine with or after food can help with this.

•Feeling drowsy, tired, or a little dizzy – These usually go away with time, but until then, it's important to move carefully and not drive or use machinery.

●Opioids can also cause more serious side effects. For example, if you take too much of an opioid, it can cause problems like not breathing enough.

●For treating acute pain, opioids are often prescribed as "immediate-release" pills. These work within 30 to 60 minutes, and wear off after 4 to 6 hours. They are also available as liquids, suppositories, and shots for people who cannot swallow pills. Opioid shots are usually given in the hospital, not at home. The table shows different opioids used to treat acute pain (table 1).

●Doctors usually prescribe the lowest dose possible, for the shortest amount of time possible. This usually means a few days or a week.

●If your doctor prescribes an opioid, they will usually tell you to take an NSAID, acetaminophen, or both as well. This is to help keep your pain under control so you can use less of the opioid. Some opioids come combined with acetaminophen or an NSAID in the same pill. If your medicine has both, do not take any extra NSAIDs or acetaminophen without talking to your doctor first. Taking too much NSAID or acetaminophen can be harmful.

●If you are pregnant, talk with your doctor about your options for treating pain. There are risks to taking opioids during pregnancy, especially if it is for more than a few days.

●In some cases, taking opioids can lead to misuse or opioid use disorder:

•"Opioid misuse" means taking an opioid in a different way than how your doctor prescribed. An example is taking the opioid when you do not need it for pain. If you take too much at once, or take opioids with alcohol or certain other drugs, it can cause serious harm or even death from overdose.

•"Opioid use disorder" is when a person can't control their use of the opioid. A person with opioid use disorder might use more medicine than they planned to. They might need higher doses to get the same effect they used to get with fewer pills or a lower dose. Or they might want to stop or use opioids less often, but not be able to.

There are things you can do to stay safe if you need to take an opioid medicine. These things help protect yourself and others:

●Follow your treatment plan carefully. Take only the amount of medicine your doctor prescribes, and only as often as they tell you to. Different people need different doses. Never take opioids that were not prescribed to you or give your opioids to other people. Talk to your doctor or nurse if you think your opioids are not helping enough with your pain.

●Do not drink alcohol while you are taking opioids.

●Do not take opioids with medicines that make you sleepy, unless your doctor tells you to. Examples include "benzodiazepines" like diazepam (sample brand name: Valium) or alprazolam (sample brand name: Xanax), muscle relaxants like baclofen or cyclobenzaprine (brand name: Flexeril), or sleeping pills like zolpidem (sample brand name: Ambien).

●Do not drive a car, use dangerous machinery, or do other risky activities while taking an opioid. Opioids can make you feel tired or have trouble thinking clearly.

●Do not take herbal medicines, sports supplements, or other dietary supplements with an opioid, unless your doctor says this is OK. These products are not tested for safety with opioids.

●Store your opioids in a safe place, such as a locked cabinet. This prevents children, teens, or anyone else from getting to them.

●Follow your doctor's instructions about how to stop taking your opioid once your pain has improved. This usually involves reducing the dose gradually if you have been taking it for more than a few days. This is called "tapering."

●When your pain gets better, get rid of any leftover medicines. Your doctor, nurse, or pharmacist can suggest ways to get rid of them. This might involve flushing them down the toilet or mixing them with something like dirt or cat litter, then putting the mixture in a sealed container in the trash. Some police stations and pharmacies also take leftover medicines.

●Try to get all your pain medicines from the same doctor. If that is not possible, make sure all your doctors know every medicine you take, even non-prescription ones. Bring a complete list of all your pain medicines and other medicines with you whenever you go to a doctor, nurse, dentist, or pharmacist. Ask your doctor or pharmacist if it is safe to take your other medicines with your pain medicines.

When should I call for help? — 

If you are taking an opioid, it's important to be aware of possible side effects and when to get help.

Call for an ambulance (in the US and Canada, call 9-1-1) if you took too much of an opioid medicine or think someone is having a drug overdose. Signs of an opioid overdose include:

●Extreme sleepiness

●Slow breathing, or no breathing at all

●Very small pupils (the black circles in the center of the eyes)

●Very slow heartbeat

An opioid overdose can be treated with a medicine called "naloxone." This can save the person's life. But it needs to be given as soon as possible.

Also call for an ambulance if you have a sudden and severe side effect like a seizure, serious allergic reaction, muscle stiffness, or very low blood pressure (which can cause dizziness or fainting).

Call your doctor or nurse if you have serious side effects such as:

●Severe nausea, vomiting, or itchiness – If you have any of these, your doctor might switch you to a different medicine.

●Feeling very sleepy, or having trouble thinking clearly – Your doctor might adjust your dose.

●Feeling dizzy or lightheaded, or falling down

Most people who take opioids on-and-off for a few days or a week do not have trouble stopping all at once. But if you have been taking an opioid on a regular schedule around the clock for several days or more and then stop suddenly, you might have unpleasant symptoms. This is called "withdrawal." These can include a stomach ache, diarrhea, or shakes. Doctors usually recommend reducing your dose gradually to help avoid withdrawal.

Tell your doctor or nurse if you are having trouble managing your pain or have questions about how to take your medicine.

How can I learn more about my medicine? — 

For more detailed information about your medicines, ask your doctor or nurse for the patient drug information handout from UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

More on this topic

Patient education: Managing pain after surgery (The Basics)
Patient education: Taking opioids safely (The Basics)
Patient education: Opioid use disorder (The Basics)
Patient education: Opioid overdose (The Basics)
Patient education: How to give naloxone (The Basics)
Patient education: Cold therapy for pain (The Basics)
Patient education: Meditation (The Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (The Basics)
Patient education: How to use topical medicines (The Basics)
Patient education: Nerve blocks (The Basics)
Patient education: Continuous infusion pain pump (The Basics)
Patient education: Patient-controlled analgesia (The Basics)
Patient education: Side effects from medicines (The Basics)
Patient education: Brand versus generic medicines (The Basics)
Patient education: Taking medicines when you're older (The Basics)
Patient education: Taking medicines during pregnancy (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Chronic pain (The Basics)

Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)