[Health Q&A] Pain Management Center · Patient Health Education

[Health Q&A] Pain Management Center · Patient Health Education

01 What is Pain?
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. It is a complex subjective experience. As the fifth vital sign, it is categorized into types like inflammatory pain, neuropathic pain, and cancer pain, requiring management through multimodal comprehensive therapy (including medications, minimally invasive interventions, psychological support, etc.). The Pain Management Department specializes in diagnosing and treating chronic pain, neurogenic pain, and conditions such as trigeminal neuralgia and postherpetic neuralgia.

02 What is Cancer Pain?
Cancer pain is caused by direct tumor invasion, nerve compression, tissue damage, or anti-cancer treatments (like radiotherapy/chemotherapy). It is characterized by persistence, progressive worsening, and multidimensional aspects (physical and psychological). Comprehensive management follows the three-step analgesic ladder (non-opioids → weak opioids → strong opioids) and may include minimally invasive interventions.

03 What Are the Harms of Pain?
The harms of pain include:

1. Physical Impact: Leads to sleep disorders, loss of appetite, endocrine disturbances (e.g., abnormal blood pressure/blood sugar), and muscle spasms.
2. Psychological Impact: Triggers anxiety, depression, and even suicide due to unbearable suffering.
3. Social Function: Limits mobility, increases healthcare burden, and reduces quality of life.

04 What Type of Pain Do You Have?
Pain types can be classified as Nociceptive Pain (e.g., sharp, dull ache), Neuropathic Pain (e.g., burning, electric shock-like), and Mixed Pain (e.g., cancer pain). Diagnosis should consider pain characteristics (stabbing/distending), duration (acute/chronic), and associated symptoms (radiating pain/numbness).

05 Why Treat Pain?
Pain treatment alleviates suffering, improves quality of life, and prevents long-term consequences like anxiety, depression, sleep disorders, and weakened immunity. Chronic pain can cause central sensitization, creating a vicious cycle, necessitating early intervention to block this pathological process. Standardized analgesia for intractable pain like cancer pain reduces complications and may extend survival.

06 Can I Stop Medication Once Pain Relieves?
Whether to stop medication after pain relief depends on the pain type and cause:

1. Acute Pain (e.g., trauma, post-surgery): Medication can be tapered off after symptoms resolve.
2. Chronic Pain (e.g., neuropathic pain): Requires full-course treatment. Sudden withdrawal can cause rebound pain or worsened central sensitization. Taper dosage gradually under medical guidance.
3. Opioids: Do not stop abruptly. Must be tapered according to protocol to avoid withdrawal symptoms.

07 Why Take Pain Medication on a Schedule?
Taking pain medication on schedule maintains stable blood concentration, prevents pain flare-ups and central sensitization. Especially for chronic pain (e.g., cancer pain), regular dosing effectively controls symptoms, reduces breakthrough pain risk, and minimizes the potential for overdose or side effects due to pain fluctuations.

08 How to Describe Your Pain to the Doctor?
When describing pain to your doctor, clearly express the following:

• Location: Specify the most painful area and any radiation (e.g., "left shoulder pain with arm numbness").
• Character: Use metaphors (e.g., "knife-like," "electric shock," or "dull pressure").
• Pattern: Triggers (e.g., movement, cold), aggravating/alleviating factors (e.g., relieved by rest).
• Timeline: Duration, frequency (e.g., "three times daily, lasting 30 minutes each").Inform your doctor if pain affects your mood or daily life. They will develop a plan based on your description and examinations. Remember to bring your past medical records and medication history.

09 How to Self-manage During a Breakthrough Pain Episode?
During a sudden breakthrough pain episode, take these emergency measures:

• Stop activity immediately, adopt a quiet, comfortable position (sitting/lying down) to avoid aggravating pain.
• Apply cold or heat: Ice packs within 48 hours of acute injury; heat packs for chronic pain to promote blood flow.
• Take medication as prescribed: If you have fast-acting pain relievers (e.g., tramadol, nitroglycerin), take sublingually or orally.
• Adjust breathing: Practice slow, deep breaths to ease tension and lower pain sensitivity.Seek immediate medical attention if pain persists unrelieved or is accompanied by symptoms like confusion or vomiting.

10 Which is More Important: Treating the Tumor or Treating Pain?
Tumor treatment and pain management are equally important and must be coordinated. Effective pain control improves quality of life and tolerance for anti-tumor therapy, while tumor treatments (surgery/chemoradiotherapy) are fundamental for potentially curing pain. For advanced cancer patients, pain relief should be a core focus to achieve the goal of "pain-free survival."

11 Should We Request "Dolantin" (Pethidine) for Unbearable Cancer Pain?
For severe cancer pain, Dolantin (pethidine) can be a short-term analgesic option but is not the first choice. Its analgesic effect is brief (2-4 hours), its metabolite can cause neurotoxicity (tremors, seizures), and long-term use risks addiction. Current guidelines recommend long-acting opioids like morphine or fentanyl for stable pain control and suitability for long-term management (oral/transdermal). If pethidine is used, strictly follow medical guidance regarding dosage, frequency, and side effect monitoring.

12 Understanding Pain Assessment: How to Accurately Describe Pain Intensity?
Common pain assessment tools include the Numerical Rating Scale (NRS), Visual Analog Scale (VAS), and Faces Pain Scale (FPS). Patients should quantify intensity on a 0-10 scale (0=no pain, 10=worst imaginable) or use facial expressions/line marking to objectively describe pain level, aiding accurate medical assessment.

13 What to Do About Constipation from Long-term Oral Pain Medication?
For constipation caused by long-term oral pain medication:

• Adjust medication: Consider switching opioids or adding laxatives/stool softeners.
• Increase dietary fiber (25-30g daily) and ensure adequate fluid intake (≥1.5L daily).
• Perform abdominal massage (clockwise, 10-15 minutes/session).
• Consult your doctor if symptoms persist for prescription of osmotic laxatives (e.g., lactulose) or prokinetics (e.g., mosapride).

14 What to Do About Nausea/Vomiting from Long-term Oral Pain Medication?
For nausea/vomiting caused by long-term oral pain medication:

• Adjust medication: Switch to drugs with less GI irritation (e.g., acetaminophen instead of NSAIDs) or add gastroprotective agents (e.g., sucralfate, omeprazole).
• Optimize dosing: Take with or after meals, avoid limosis, reduce single doses.
• Symptom management: Drink small amounts of water frequently; use antiemetics short-term if needed (e.g., metoclopramide).
• Seek medical evaluation if symptoms persist or worsen to rule out complications like ulcers or drug allergy.

15 Should Cancer Pain Be Endured, Thinking It Will Pass?
Cancer pain should NOT be endured. Enduring pain worsens central sensitization, lowers pain threshold, and may accelerate tumor progression. The WHO recommends stepwise analgesic therapy; over 80% of cancer pain can be effectively controlled with standardized medication. Patients should actively report pain to their doctor, avoiding self-endurance or misuse of analgesics.

16 Is Treating the Tumor Enough if Pain is Caused by It?
Tumor-related pain requires comprehensive treatment. Solely controlling tumor growth may not fully relieve pain. Based on the pain mechanism (e.g., nerve compression, inflammation), combine stepwise therapies like medications (opioids, NSAIDs), radiotherapy, nerve blocks, along with psychological support and rehabilitation.

17 Are Painkillers Addictive?
Addiction potential depends on the drug type:

• Non-opioids (e.g., ibuprofen, acetaminophen) are not addictive and are safe for mild-moderate pain.
• Opioids (e.g., morphine, fentanyl) require strict medical supervision. Long-term abuse can lead to addiction, but the risk is very low when used properly for pathological pain like cancer pain. Rational use is key—avoid self-adjusting doses or long-term misuse.

18 Is Needing Increasing Doses or Difficulty Stopping Medication a Sign of Addiction?
Increasing dosage needs or difficulty stopping medication may indicate dependence or addiction. Opioids (e.g., morphine, tramadol) can cause physical dependence (tolerance, withdrawal symptoms like anxiety/sweating). Non-opioids (e.g., ibuprofen) are typically non-addictive but long-term misuse may cause rebound pain. Always use medication under medical guidance and avoid self-adjusting or abrupt discontinuation.

19 What Are the Treatment Methods for Cancer Pain?
Cancer pain treatment follows the three-step principle:

• Mild pain: Nonsteroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen, acetaminophen).
• Moderate pain: Weak opioids (e.g., tramadol, codeine).
• Severe pain: Strong opioids (e.g., morphine, fentanyl).Additional options include interventional therapies (nerve blocks, intrathecal pumps), anti-tumor treatments (radiotherapy/chemotherapy), psychological interventions, and physical therapies (e.g., music therapy).

20 Family Support for Pain Patients
Family members can support pain patients through multidimensional efforts:

• Psychological Support: Listen patiently, encourage and provide guidance to alleviate anxiety and depression.
• Daily Care: Assist with positioning, provide a comfortable environment (soft padding, suitable temperature/humidity).
• Treatment Supervision: Encourage timely medication, record symptom changes, and accompany to appointments.
• Nutrition & Rehabilitation: Provide balanced nutrition (high-protein, B vitamins) and assist with rehabilitation exercises.