UCSF School of Nursing
Golden Gate Bridge
  

The PRO-SELF© PAIN CONTROL
PROGRAM
Christine Miaskowski, RN, PhD, FAAN
Professor and Chair,
Department of Physiological Nursing
ProSelf-logo

  1. Pain Control Booklet
  2. Pain Control Booklet - Teaching Guide
  3. Pain Management Diary
  4. Script for Discussing Prescription
 

The PRO-SELF© PAIN CONTROL BOOKLET

Adapted from:
 Ferrell, B. R.; Ferrell, B. A.; Ahn, C; & Tran, K. (1994). Pain management for elderly patients with cancer at home. Cancer, 74 (7, Suppl.), 2139-2136.

  1. Introduction: (p.2)
    • This booklet is written to help you manage your pain. Your nurse will talk with you about the information in this booklet and answer any of your questions.
    • Remember: Our goal is to help you get the best possible pain relief with very few side effects.
    • The approach used in this booklet is to review a series of statements and point out some very important things for you to remember about pain and pain control.

  2. Cancer pain can be effectively relieved

    3. DISAGREE
    [  ]

     

    		 AGREE
    [X]

    • 90% of all cancer pain can be relieved with oral pain medicines.
    • Pain medicines will be adjusted until we get the right dose to control your pain.

  3. Pain medicines should only be given when pain is severe

    4. DISAGREE
    [X]
    		   AGREE
    [  ]

    • Pain medicines should be given on a regular schedule to keep your pain under control.
    • Pain can interfere with sleep, visiting with family and friends, and doing your work.
    • It is better to keep pain under control.

  4. Addiction refers to a person's desire to use drugs for their effects on the mind or emotions rather than for the medical use of relieving pain. Most cancer patients on pain medicines will become psychologically addicted to the medicines over time

    5. DISAGREE
    [X]
    		   AGREE
    [  ]

    • The first sentence of the above statement is true.
    • The second sentence of the above statement is FALSE.
    • Cancer patients taking pain medicines do not become addicted to their pain medicines.
    • Cancer patients with pain need to take their pain medicines to control their pain just like diabetics have to take their insulin to control their diabetes.

  5. Drug dependence means that a person would go through withdrawal if a pain medicine were stopped. Most cancer patients on pain medicines will become physically dependent on the medicines over time

    6. DISAGREE
    [  ]
    		   AGREE
    [X]

    • Both sentences are true.
    • Cancer patients taking pain medicines will become dependent on their pain medicines.
    • You must NOT stop taking your pain medicines when your pain is under control.
    • Your pain medicines must be stopped SLOWLY if you don't need to take them any more.

  6. It is better to give the lowest amount of medicines possible early on so that larger doses can be used later if pain increases.

    7. DISAGREE
    [X]
    		   AGREE
    [  ]

    • Pain medicines can be given in big enough doses to control your pain.
    • If one pain medicine does not control your pain, you can receive a different pain medicine.
    • Sometimes MORE THAN ONE medicine will be given to control your pain.

  7. It is better to give pain medicines around the clock (on a schedule) rather than only when needed

    8. DISAGREE
    [  ]
    		   AGREE
    [X]

    • Pain medicines should be taken on a regular schedule to keep your pain under control.
    • Taking your pain medicines on a schedule keeps the blood level of pain medicine constant and helps keep your pain under control.

  8. Treatments other than medicines (such as massage, heat, and relaxation) can be effective for relieving pain

    9. DISAGREE
    [  ]
    		   AGREE
    [X]

    • Other treatments can be done while taking your pain medicines.
    • You need to try some of these other treatments to see which ones work best for you.

  9. Pain medicines can often interfere with breathing

    10. DISAGREE
    [X]
    		   AGREE
    [  ]

    • Pain medicines given to treat cancer pain usually do NOT affect your breathing.
    • However, one of the major problems with pain medicines is constipation.
    • Some things you can do to prevent constipation are:
      1. Drink 4-6 glasses of water a day.
      2. Drink a small glass of prune juice everyday.
      3. Eat fruits and vegetables.
      4. Take the following medicines:
        Colace, 100 mg - 200 mg, two or three times a day;
        Senna, 1 to 2 pills before bed.

  10. Patients are often given too much pain medicine

    11. DISAGREE
    [X]
    		   AGREE
    [  ]

    • Most cancer patients in pain take too LITTLE pain medicine.

  11. IN CONCLUSION
    • Tell your doctor or nurse if you are having pain.
    • If you are having pain your pain medicine may need to be changed.
    • Take your pain medicine on a schedule to keep your pain under control.
    • The goal is to keep your pain under control.
 
   
  1. Pain Control Booklet
  2. Pain Control Booklet - Teaching Guide
  3. Pain Management Diary
  4. Script for Discussing Prescription

Teaching Guide 
 The PRO-SELF©: PAIN CONTROL BOOKLET

Booklet

Additional Information
  1. Introduction (p.2)
  • This booklet is written to help you manage your pain. Your nurse will talk with you about the information in this booklet and answer any of your questions.
  • Remember:  Our goal is to help you get the best possible pain relief with very few side effects.
  • The approach used in this booklet is to review a series of statements and point out some very important things for you to remember about pain and pain control.
  1. Emphasize the importance of helping the patient get the best possible pain relief with the fewest side effects.
  2. Emphasize the importance of good pain control. Good pain control should improve the patients' mood, their functional status, and their quality of life.
  1. Cancer pain can be effectively relieved.
AGREE (p. 3)
  • 90% of all cancer pain can be relieved with oral pain medicines.
  • Pain medicines will be adjusted until we get the right dose to control your pain.
  1. A recent report from the US Public Health Service has stated that 90% of all cancer pain can be relieved with oral medicines. No fancy equipment is required in most cases to get cancer pain under good control.
  2. Every patient is a little bit different and reacts differently to different types of pain medicine.
  3. Patients sometimes need more than one kind of medicine to control their pain. Sometimes the doses of pain medicine need to be increased or decreased to get exactly the right dose for good pain control with minimal side effects.
  1. Pain medicines should only be given when pain is severe.
DISAGREE (p. 4)
  • Pain medicines should be given on a regular schedule to keep your pain under control.
  • Pain can interfere with sleep, visiting with family and friends, or doing your work.
  • It is better to keep pain under control.
  1. The reason that pain medicines need to be given on a regular schedule is that the level of pain medicine in your blood must be kept constant in order to keep your pain under control.
  2. The type of pain you have is a constant type of pain that we call chronic pain.
  3. Taking the pain medicine only when your pain is severe will not keep your pain under control
  4. In many instances, if you do not keep your pain under control, you will not be able to sleep as well, you will not be able to socialize with your family or friends, or you will not be able to do what you enjoy doing.
  5. You may be able to use a lower dose of pain medicine if you take the medicine on a schedule rather than only when you really need it.
  1. Addiction refers to a person's desire to use drugs for their effects on the mind or emotions rather than for the medical use of relieving pain. Most cancer patients on pain medicines will become psychologically addicted to the medicines over time.
DISAGREE (p. 5)
  • The first sentence of the above statement is true.
  • The second sentence above is false.
  • Cancer patients taking pain medicines do not become addicted to their pain medicines.
  • Cancer patients with pain need to take their pain medicines to control their pain, just like diabetics have to take their insulin to control their diabetes.
  1. The first sentence of the statement is the definition of addiction.
  2. Cancer patients DO NOT become addicted to pain medication.
  3. Cancer pain is a chronic condition. Like any chronic condition (for example, diabetes), your pain requires ongoing treatment. The pain medicine is being used to treat pain just like insulin is used to control diabetes.
  1. Drug dependence means that a person would go through withdrawal if a pain medicine were stopped. Most patients on pain medicines will become physically dependent on the medicines over time.
AGREE (p. 6)
  • Both sentences are true.
  • Cancer patients taking pain medicines will become dependent on their pain medicines.
  • You must NOT stop taking your pain medicines when your pain is under control.
  • Your pain medicines must be stopped slowly if you don't need to take them any more.
  1. Pain medicines, like morphine, work by attaching to an opioid receptor. Over time, the receptors become used to the medicine.
  2. The fact that patients' become dependent on pain medicines is not a problem. If the cause of your pain goes away, your pain medicine can be decreased gradually.
  3. If you were to stop your pain medicines abruptly, you could experience withdrawal symptoms (like a bad flu). You must not stop taking your pain medicines when your pain is under control. Your doctor will need to tell you how to decrease the dose of pain medicine if you do not need the medicine any longer.
  1. It is better to give the lowest amount of medicines possible early on so that larger doses can be used later if pain increases.
DISAGREE (p. 7)
  • Pain medicines can be given in big enough doses to control your pain.
  • If one pain medicine does not control your pain, you can receive a different pain medicine.
  • Sometimes more than one medicine will be given to control your pain.
  1. Pain medicine will NOT stop working. But sometimes your body will get used to the medicine. This effect is called tolerance.
  2. Tolerance is not usually a problem with cancer pain treatment because the amount of medicine can be changed or other medicines can be added.
  3. Cancer pain can be relieved, so don't deny yourself pain relief now.
  1. It is better to give pain medicines around the clock (on a schedule) rather than only when needed.
AGREE (p. 8)
  • Pain medicines should be taken on a regular schedule to keep your pain under control.
  • Taking your pain medicines on a schedule keeps the blood level of pain medicine constant and helps keep your pain under control
  1. Cancer pain is a chronic pain problem. Chronic pain requires ongoing treatment.
  2. It is extremely important to maintain a sufficient amount of pain medicine in your blood to keep your pain under control.
  3. We will review your pain medication schedule prior to my leaving today.
  1. Treatments other than medications (such as massage, heat, relaxation) can be effective for relieving pain.
AGREE (p. 9)
  • Other treatments can be done while taking your pain medicines.
  • You need to try some of these other treatments to see which ones work best for you.
  1. Are you using any of these treatments for your pain? If so, which ones, and how effective are they?
  2. Use these non-pharmacologic therapies as added interventions. The non-pharmacologic interventions should NOT take the place of, or be used instead of, your pain medicine.
  1. Pain medicines can often interfere with breathing.
DISAGREE (p. 10)
  • Pain medicines given to treat cancer pain usually do NOT affect your breathing.
  • One of the major problems with pain medicines is constipation.
  • Some things you can do to prevent constipation are:
  1. Drink 4-6 glasses of water a day.
  2. Drink a small glass of prune juice everyday.
  3. Eat fruits and vegetables.
  4. Take the following medicines:
    Colace, 100 mg to 200 mg, two to three times a day
    Senna, 1 to 2 pills before bed
  1. Respiratory depression (breathing problems) is not a problem for patients who take pain medicine for cancer-related pain.
  2. Are you having constipation?
    If so, I recommend the treatments in this booklet. (Colace and Senna can be bought in the drug store.)
  1. Patients are often given too much pain medicine.
DISAGREE (p. 11)
  • Most cancer patients in pain take too little pain medicine.
  1. Recent studies show that patients are not given enough pain medicine by their doctors, and they take even less because:
    • they worry about becoming addicted
    • they worry about side effects
    • they worry there will not be enough medicine when they really need the medicine
  2. As we discussed previously, cancer patients do not become addicted to pain medicine.
  3. Side effects of pain medicines can be controlled.
  4. The doses of pain medicine can be increased in order to keep a patient's pain under control.
  1. In Conclusion: (p. 12)

  • Tell your doctor or nurse if you are having pain.
  • If you are having pain, your pain medicine may need to be changed.
  • Take your pain medicine on a schedule to keep your pain under control.
  1. These items are the major points of the program.

  1. Pain Control Booklet
  2. Pain Control Booklet - Teaching Guide
  3. Pain Management Diary
  4. Script for Discussing Prescription
 

PRO-SELF© Pain Management Diary

The following is a sample page from the PRO-SELF© Pain Management Diary patients can use to record the intensity of their pain and all analgesic and co-analgesic medications they take for pain.

Patients are instructed to complete the diary at the end of each day before bedtime. They record their pain at its worst, least, and average intensities using the 0-10 numerical rating scale (with 0 being no pain and 10 being the worst pain imaginable). The word descriptors on the numerical rating scale may be helpful for patients when thinking about how to rate their pain.

Patients also record on the bottom half of the diary all analgesic and co-analgesic medications they took for their pain, indicating those they took on a routine schedule (i.e. around-the-clock) or on an as-needed (extra) basis.


Date: ________________

Please fill out this page before going to bed, keeping in mind how your pain was during the day.

0

1

2

3

4

5

6

7

8

9

10

NO PAIN

  

MILD

    

MODER- ATE

    

SEVERE

  

WORST PAIN IMAGIN- ABLE

1. Using the scale above, choose a number that best describes:
  A. The average amount of pain
            you experienced today

 
  B. The least amount of pain
           you experienced today

 
  C. The worst amount of pain
           you experienced today

 
2. How many hours did you have pain today?

(0-24 hours)

Directions: At the end of each day, please circle the times you took your routinely scheduled pain medicine and any extra pain medicine you needed.

  Medicine Time
Routine    
     
Extra    
     
     



  1. Pain Control Booklet
  2. Pain Control Booklet - Teaching Guide
  3. Pain Management Diary
  4. Script for Discussing Prescription
 

Script for Discussing a
Change in the Pain Prescription
with the Health Care Provider

The following is a recommended script for patients (or family caregivers) to use when speaking with a health care provider regarding a need to change the pain prescription.

 

Hello, Dr. ____________________, this is ____________________. I'm calling to talk with you about the pain I'm having.

Over the past week, my pain has been a(n) ______ on a 0 to 10 rating scale. The pain has been so severe that I have not been able to sleep, do my usual activities, or visit with my friends.

I've been taking my pain medicine as you prescribed it. I've also been taking ______ additional doses of medicine every day. The medicine isn't working. Can we change the pain medicine so I can get better pain control?



Revised: 
Nov. 2003

  

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