Making better use of medicines

Start by checking to see which types of medicines you are using. Which of these do you take at present?

Analgesics:

Paracetamol+/–Codeine

Codeine

Dihydrocodeine

Tramadol

Morphine

Oxycodone

Buprenorphine

Fentanyl

Other?

Anti-inflammatories:

Ibuprofen

Diclofenac

Indomethacin

Other?

Anti-depressants:

Amitriptyline

Dothiepin

Imipramine

Other?

Anti-convulsants:

Carbamazepine

Gabapentin

Lamotrigine

Other?

Creams or gels:

Capsaicin cream

Diclofenac gel

Other?

Make a list in your notebook of all the medicines, including remedies, that you take at present.

Overall, what level of relief do you get from your medicines on a typical day?

Put a mark X on the line below to indicate how much relief on average you get from using your pain-relief medicines:

Four suggestions for using medications more helpfully

At present, you may find yourself taking a lot of different tablets to reduce pain. This may mean that you are taking too many, too often and perhaps experiencing side-effects or interactions with other medicines. If you think this is happening, try Suggestion A (below), using a medicine diary. (If you are concerned or uncertain about your pain-relief medicine, then discuss the problem with your doctor or specialist pain nurse first.)

Medicine is just one way of controlling persistent pain. Staying or getting active, stretching and exercising, relaxation skills, pleasurable activities, learning distraction techniques and even staying or returning to work can also contribute to better pain control.

SUGGESTION A

Keeping a diary for three to four days will enable you to see your pain patterns during the day and at night-time. The diary will help you monitor your use of medication, in different situations and moods and with different pain levels.

There is a spare Medicines Use Diary sheet, if you need it, at the back of the book (see p. 296).

SUGGESTION B

How severe does the pain get before you take or change your medication?

Put a mark X on the line below to indicate how severe the pain is:

Waiting until pain levels are very high (say 7–10) is usually an unhelpful way to use medicines. This is called ‘the hanging on’ trap or the ‘wait and see’ trap, because the high pain level cannot easily be reduced with mild or moderate analgesics. Catching it sooner can work better – so try taking your pain-relieving medicines as pain levels start to rise. This may mean that you can carry on with your daily routine with less pain.

Try to predict when your pain level is likely to increase during your daytime or night-time activities. For example, pain levels can rise after physical activities or sometimes when you are stressed or angry. Then start analgesics as the pain levels start to rise.

Suggestions B and C both use the Gate Control system (see pp. 45–7) to help close the pain gate to pain messages.

SUGGESTION C

This method helps you gain better pain control by taking medicines at regular times or by the clock, not just by the pain level.

First ask yourself the following questions:

1   Do you take several types of medicines at the same time to give pain relief?

2   If the pain level stays high for two/three hours after taking pain medicine, what do you do next?

(a)   Do you, for example, take more tablets than you should to deal with the high pain levels?

(b)   Do you take tablets earlier than the next dose time to deal with the high pain levels?

(c)   Do you try something else, such as a hot bath or a distracting activity such as a puzzle game or deep-breathing relaxation?

Write what you do now in your notebook or in your Medicines Use Diary.

Taking too many types of medicines or too many tablets within two or three hours can cause side-effects or drug reactions and the pain levels may still be high.

It may help to try and take medicine at regular times. This can be four-hourly for medicines like paracetamol (though no more than eight tablets in 24 hours), or for stronger medicines like codeine, dihyrocodeine or opioids such as oral morphine. It can be ten- to twelve-hourly if using slow-release forms of medicine like dihyrocodeine, morphine, tramadol or oxycodone. Continue taking your medicine at regular times when the pain is at high levels. If you have ‘breakthrough pain’ (increased pain levels before your next dose is due), then talk to your doctor or pain specialist nurse to get help with this situation.

It may also help to match the level of pain with the strength of the medicine (see the WHO Steps One, Two and Three on p. 78). Talk to your doctor or specialist pain nurse about the use of stronger medicine for your specific situation.

Look at Steve’s Medicine and Pain Level Diary (opposite) when he was trying oral morphine solution to reduce his pain.

It can help to use a Medicine and Pain Level Diary. This allows you to record pain levels every three or four hours through the day and night and the medicines you take and when you use them. You and your doctor or pain specialist nurse can use this to see when the medications help reduce the pain. It will also enable your doctor or pain specialist nurse to see when there is breakthrough pain. They can then suggest different strengths or types of drugs to help improve pain relief. Using strong medicines, like morphine or oxycodone, for severe pain in this way is safe and rarely causes dependence or addiction. Many people stay on morphine, oxycodone or fentanyl (a medication used in patches that are stuck on to the skin) safely for years to help reduce and manage their pain.

SUGGESTION D

This involves reducing the medicines you take or stopping them over time (see below).

Have you ever thought about stopping or reducing your medications?

If ‘Yes’, is this because:

•   You are concerned about becoming dependent?

•   Side-effects are a problem?

•   You are concerned about becoming drug-tolerant?

•   You are concerned for other reasons? If so, what are they?