Controlling your pain in hospital and at home

Each person’s experience of pain is different, even after the same operation or with the same illness. Although it may not always be possible to completely get rid of your pain, you should be comfortable. 

If there is a problem, you can ask the nurse looking after you to contact the Inpatient Pain Team. 

If you have problems with pain after you leave hospital, contact your ward or day surgery (if applicable) on the number you have been given or, alternatively, contact your GP.

If pain is well controlled you get better more quickly. If you are in pain, you may have problems moving around, taking a deep breath or coughing. Good pain relief makes it more comfortable for you to move around after surgery, will help you recover more quickly, and may mean that you get home sooner. 

The nurses on the ward will ask you regularly if you have any pain and how bad it is. If you have pain at any other time, or the pain will not go away, it is important that you tell the nursing staff. 

Your pain will be treated with a combination of pain medication, physiotherapy and keeping well hydrated. Using a combination of ways to treat your pain means you are less likely to need strong pain medication like opioids. This will help to reduce the risk of unwanted side effects.

Paracetamol is a very effective pain medication when taken regularly and can reduce the amount of strong pain medication you will need. It rarely causes any side effects when taken in normal doses.

NSAIDs are very effective for mild to moderate pain, they should be taken regularly and can be given as a tablet or as a suppository (into your back passage). Ibuprofen modified release (MR) is sometimes given before surgery. Occasionally NSAIDs can be given into your vein through a drip. There are several non-steroidal anti-inflammatory drugs used in the hospital, ibuprofen (also known as Brufen or Nurofen) and diclofenac are the most commonly used. NSAIDs are given regularly with other pain medication as they reduce inflammation as well as pain. This often reduces the amount of strong pain medication needed.

A common NSAID prescribed by GPs is naproxen; you must not take naproxen with any other non-steroidal anti-inflammatory medication. Sometimes other non-steroidal anti-inflammatory drugs called COX-2 inhibitors are used, the most common being celecoxib and etoricoxib.

Side effects of anti-inflammatory pain medication

Most people can have NSAIDs but they can occasionally cause dizziness, sickness and indigestion. If you have had a stomach ulcer in the past, or have problems with your heart, liver or kidneys you may not be able to take NSAIDs. If this is the case we will suggest an alternative. If you develop indigestion whilst taking them please tell the nurse. 

Please tell the doctors or nurses straight away if you develop any of these symptoms: 

• black poo
• blood in your vomit
• blood in your urine (wee)
• not passing urine at all  

You may be prescribed tramadol, codeine or dihydrocodeine in tablet form. The nurse may give you these three or four times a day. Weak opioids are for moderate pain and when taken reduces the amount of strong pain medication you will need.

Side effects of tramadol, codeine and dihydrocodeine

Weak opioids can sometimes cause light-headedness and nausea; this can be treated by reducing the dose or with anti-sickness medication and an Acupin (very very small acupuncture pin). 

Acupuncture has been used for many years to treat many different medical problems. More recently, research has shown that using a small Acupin in the wrist is very effective in preventing and treating sickness. More information can be found in the information “Using acupuncture to reduce nausea and vomiting after your operation”. 

Codeine, dihydrocodeine and tramadol can all cause constipation but this can be treated with laxatives. 

Dependence and higher tolerance can happen as a result of repeated use, so only short-term use is recommended. 

Morphine, oxycodone and fentanyl (day surgery only)

You may be prescribed morphine or oxycodone whilst in hospital, these come in different forms, such as liquids, tablets (short and long acting) and injections. Injections are only given to you if you are unable to eat or drink. The injection will be given through a small cannula which is placed in your upper thigh.

If you need opioids after having day surgery, you will be given fentanyl through a small cannula in your hand or arm. 

Strong opioid medication is for severe pain. If you are experiencing severe pain, tell the nurse who will then assess your pain and give you the pain medication you need. Strong opioid medication is only recommended for short-term use as they can cause harm if taken for a long time. 

Morphine is the first choice of pain medication for severe pain. Oxycodone is used for patients that are allergic or sensitive to morphine, or when the side effects of morphine are unacceptable.

Side effects of strong pain medications 

All pain medications have side effects; opioids can cause drowsiness (feeling tired) and sometimes nausea (feeling sick) or vomiting (being sick). Morphine and oxycodone both cause constipation. Rare side effects include bad dreams or hallucinations. 

Nausea and vomiting can be treated with anti-sickness medication and/or an Acupin. 

If you have any of these side effects, please tell your nurse.

If you are having surgery, or are admitted to hospital in pain and need frequent injections of morphine, an alternative would be a PCA.

PCA is a small computerised pump containing strong pain medication, such as morphine or oxycodone and is connected to your drip. There is separate patient information if you have a PCA. 

You may be offered an epidural for pain relief if you are having major surgery, or are admitted with fractured ribs.

Some people having keyhole surgery have a one off dose of spinal morphine in theatre just before surgery. This type of morphine can last up to 24 hours and reduces the need for further strong pain medication. 

If you are offered these types of pain relief there is separate information available. These methods provide excellent pain relief, reduce nausea and vomiting and improve your ability to move about in comfort.

After surgery, patients who have good pain relief recover more quickly and often go home earlier. 

Yes, pain medications work better if taken on a regular basis before your pain becomes severe. This may be in the first few days after surgery, after trauma or with a very painful condition.

If you have had a local anaesthetic (numbed in the area), you should take pain relief when offered, even if you don’t have any pain. The aim is to keep your pain under control, not to wait until it is very bad before treating it. 

Strong opioids, even when prescribed by a nurse or a doctor, have a serious risk of dependence and addiction, especially with long-term use. You will only be prescribed strong opioids for a short time, as long term use of strong opioids is not recommended.

If you are on strong opioids for more than two weeks, they should not be stopped suddenly. Strong opioids should be reduced over a period of time to avoid withdrawal problems. Withdrawal symptoms include muscle and bone pain, sleep problems, diarrhoea and vomiting.

Ask your GP for advice about stopping strong opioid medication. 

Information about opioid medicines and the risk of addiction is available on Gov.uk.

You should not take codeine if you are breastfeeding; as an alternative, you can use dihydrocodeine.

It is not known how much dihydrocodeine gets into breast milk, but it is likely to be a small amount. It is better to take low doses and to only use it for a short time. This reduces the risk of your baby getting side effects. Very rare risk s can include drowsiness, vomiting and poor feeding. If you are at all concerned about this, or your baby has any of these symptoms please contact your community midwife or GP.
 

Yes, there are other ways to help control your pain, such as listening to music, relaxation and reading. These techniques can really help.

Reading a book or magazine can help you relax, and the hospital patient library has lots of these for you to borrow whilst you are in hospital.

Listening to music - you could bring in an iPad or phone filled with your favourite music but remember to bring in your headphones.

Changing position can help make you more comfortable, the nurses can help you find a comfortable position.

It is usual to get some pain following surgery, trauma or from a very painful condition. For most people, once the short term supply of weak opioids and NSAIDs have finished, paracetamol will be enough to relieve their pain. 

If you have moderate or severe pain, after taking regular paracetamol, that is stopping you from deep breathing, coughing and moving around, contact your GP.  

If you already take weak or strong opioids at home for a long-term condition, or if you have any concerns about your pain or the pain medication that you are taking, please speak to one of the nurses or doctors looking after you.  
 

It is illegal to drive whilst taking prescription medication if it impairs your driving ability.

Pain medications such as morphine, oxycodone, tramadol and codeine can all affect the ability to drive safely. Driving safely is the responsibility of the driver; you should not drive unless you feel completely competent to do so. Even if you do not feel impaired, you are more likely to suffer a road traffic collision if you are taking strong pain medication like morphine or oxycodone.  

Drugs and driving: the law - (Gov.uk)

Always keep medications in their original packaging and stored/locked away in a safe place. Keep out of sight and reach of children, adolescents and pets. Only take medications that have been prescribed for you and do not share your medications with anyone else.