The use of prescription pain relievers to combat pain caused by a chronic or life-limiting illness is a complicated issue. Prescription pain relievers should be prescribed and managed by doctors only. The purpose of this page is to provide general information on the utilization of prescription pain relievers and other medications but is NOT medical advice. For any questions or concerns with your medication – always consult your attending physician.
Use of Opioids
The most frequently prescribed pain relievers are narcotics called opiates or opioids. The drugs, widely used for many years, were initially derived from the opium poppy. Today, the majority of narcotic drugs are manufactured using synthetic chemicals. All narcotic pain medications carry similar side effects, including drowsiness and constipation. The following are examples of some frequently prescribed opioid pain medications:
All narcotic pain relievers require a doctor’s prescription. Most of these drugs come in a variety of forms allowing them to be administered by mouth, intramuscular injection, rectal suppository, or intravenously. Some pain relievers are also available in transdermal patches that allow for more continuous pain relief. In cases of severe pain, narcotic pain medications may be prescribed along with other classes of drugs that enhance their pain relieving effectiveness or reduce unpleasant side effects. Another group of pain relievers is nonsteroidal anti-inflammatory drugs, commonly referred to as NSAIDs. These medications are similar to over-the-counter ibuprofen and require a prescription for large doses. The following are examples of NSAID pain relievers:
NSAIDs are effective in treating moderate to severe pain, including pain related to bone metastasis or surgery. These medications carry no risk of physical dependence or drug tolerance since they are not narcotics. Some NSAIDs are more effective than others and may be used in combination with other pain relievers in cases of moderate to severe pain.
How Do I Determine Which Pain Relievers Are Right For Me?
You should discuss your pain management options with a pharmacist, nurse, or doctor before starting any medication. You should never take someone else’s pain medication. What worked for a friend or family member may not work for you and may even cause dangerous interactions with your other medications. You should only use one doctor to prescribe your pain medications. This allows them to monitor the efficacy of the treatment and ensures that you are taking the correct amount.
If you receive treatment from multiple doctors, make sure that all of your medical providers are aware of your pain medication regimen. Your pain medication needs may change during the course of your treatment. You should keep a log detailing the type and amount of pain medication that you are taking as well as its effect in controlling your pain. By sharing this information with your doctor or nurse, you can work together to create a pain relief regimen that works for you.
Can I Become Addicted to Narcotic Pain Medications?
The risk of narcotic addiction is very small when the medication is used under medical supervision to treat chronic pain. Most people who use narcotics to treat prolonged pain express fears about addiction. You may even have friends or family that voice concerns about addiction. Much of the fear concerning the use of narcotics for pain management comes from a misunderstanding about what constitutes addiction. The truth is that drug addiction is not the norm and you should not let fear stop you from using these medications to relieve your pain.
An addict is someone who uses drugs to satisfy emotional, psychological, or physical needs. Addicts use drugs for the pleasure it brings them. Using narcotics for a valid medical reason, such as pain relief, is not addiction. In fact, the majority of patients who use narcotic pain relievers can stop the medication if their pain is controlled by other options.
If you and your doctor determine that narcotics are the best method to manage your pain, you should not let fear or other people’s concerns stop you from taking the medication as prescribed. Remember, your comfort is more important that the slight risk of addiction.
Can I Develop Drug Tolerance?
If you take narcotic pain relievers for a prolonged time, you may find that they gradually become less effective. You may find that you require larger and more frequent doses of your medication either due to an increase in your pain level or drug tolerance. Changing you medication regimen due to tolerance or increased pain is not unusual as your disease or treatment progresses.
It is important to understand that drug tolerance is not the same as addiction. You should always let your doctor know if your medication is no longer effectively control your pain so that you can discuss available options.
Are Narcotic Pain Relievers Dangerous?
Narcotics, like any other medication, may be dangerous if taken improperly. You should always follow your doctor’s instructions regarding dosing and never adjust your medication yourself. The potential risks of narcotics include drug interactions, overdose, or accidents caused by drowsiness.
Possibility of Overdose
Large doses of opioids can cause respiratory depression where your breathing is too slow or even stops. This is very rare since doctors carefully prescribe doses that manage pain but have little effect on respiration. Drug addicts frequently die of drug overdoses, but this is due to taking the narcotic in combination with other drugs, an extremely large dose, or the impurities common in illegal drugs. Someone should contact your nurse or doctor immediately if you have trouble waking up or experience unusual sleepiness.
One of the primary side effects of narcotics is drowsiness or sleepiness. This side effect is usually most noticeable when you first start taking the medication and should improve within a few days. You should avoid driving and using dangerous or heavy equipment while taking these drugs. You should also take extra precautions when walking up or down stairs since you may be more prone to falling.
Narcotics can be dangerous if taken with tranquilizers, alcohol, antihistamines, antidepressants, or sleeping aids. Even small doses of these medications in combination can cause overdose symptoms, including confusion, difficulty breathing, increased drowsiness, weakness, dizziness, or anxiety. In extreme cases, these interactions can result in unconsciousness or even death. Make sure you tell your doctor about all over-the-counter and prescription medications that you are currently taking and any medications that make you sleepy.
What Dose is Considered Safe For Narcotic Pain Relievers?
It is important to understand that medications affect people differently. What works for someone else may not work for you. Your doctor will determine what dose of pain reliever is appropriate for you. As your pain level or tolerance for the drug changes, you may require doses that may have been considered too high previously. When discussing pain management with your doctor, you should ask the following questions:
- How much and how often should I take my medication?
- Can I take more if it does not relieve my pain? If so, how much?
- Should I call you before increasing my dose?
- What should I do if I forget a dose or take it late?
Your physician will prescribe your medication at a dose that he or she believes will be safe and adequate to control your pain. The goal is to find the minimum dosage that controls your pain with a minimum of side effects. You should notify your doctor immediately if you experience trouble breathing, extreme drowsiness, or the medication does not control your pain. The doctor or nurse can tell you how to adjust your medication appropriately. You should never change your medication without medical supervision.
What If My Pain Medication Doesn’t Work?
You shouldn’t wait until your next appointment to discuss the issue with your doctor. You should call your nurse or doctor as soon as possible if your medication is not controlling your pain. You will need to provide them with the following information:
- How is the pain impacting your daily activities?
- How much pain relief, if any, does the medication provide?
- Are you experiencing any side effects, such as drowsiness?
- How long does the medication relieve your pain?
Effective pain relief requires communication between you and your doctor. If your medication is not effectively controlling your pain, there are options available, including:
- Taking a larger or more frequent dose.
- Switching to another type of medication.
- Switching to a long-acting form of the medication. For example, morphine is available in long-acting sustained released tablets.
- Switching to a different medication delivery method such as automated pumps that deliver medication intravenously or subcutaneously.
The fact that your medication is not working as well as it did may be a sign that your pain level is increasing or that you have developed a drug tolerance. The goal is to provide effective pain relief with as few side effects as possible, regardless of the dose. Of course, you should never increase your dose without consulting your doctor. If your doctor is reluctant to change your dose or seems unfamiliar with the latest pain management alternatives, you should ask to speak with a pain management specialist.
Many patients are afraid to take their pain medication as often as prescribed. They put off taking medication either out of fear of addiction or because they do not like the side effects. Pain medication is much more effective if taken before pain reaches an unbearable level. As mentioned earlier, taking prescribed medication for pain management is not the same as addiction. You should let your doctor know if side effects are keeping you from taking your pain medication so that they can look at other alternatives.
What Side Effects Could I Have While Taking Narcotics?
Most side effects from narcotic pain medications are most noticeable when first starting the medication and may resolve with time. The most common side effects of narcotic pain relievers include:
- Nausea and vomiting
- Difficulty urinating
- Decrease in the depth and rate of breathing
- Mental effects including confusion, hallucinations, or nightmares
Some people do not experience any side effects. You should always discuss side effects with your nurse or doctor since most side effects can be easily managed with other medications or by adjusting the dose.
What Should I Do If I Experience Drowsiness?
In most cases, the drowsiness should disappear within a few days. The drowsiness may be caused by your decreased pain, especially if you are getting pain relief for the first time. Your body is finally able to relax enough to get the rest that it needs, and the drowsiness should improve once you “catch up” on sleep. You should avoid or take extra precautions when engaging in situations and activities requiring mental alertness, such as driving, climbing stairs, or cooking. Other options for dealing with drowsiness include:
- See if your drowsiness is caused by other factors, such as other medications that you may be taking.
- Let your doctor know if you are still in pain even with the medication. Continued pain affects sleep and can be physically draining causing you to feel drowsy. In this case, the sleepiness should improve once you achieve better pain control.
- Ask your doctor about prescribing smaller, more frequent doses.
- Ask your doctor about using caffeine or a prescription stimulant.
Consult your doctor or nurse immediately if your drowsiness does not improve, is severe, or occurs after you have been taking the medication for a while.
How Can I Prevent Opioid-Induced Constipation?
Most people experience constipation while taking narcotics. The medication slows the movement of the stool through the digestive tract. This causes more water to be absorbed from the stool causing it to become hard and difficult to pass. Most doctors prescribe laxatives or stool softeners for patients taking narcotic pain relievers. You can also try the following after consulting your health care provider:
- Increase your intake of foods high in roughage or fiber, such as whole grains and uncooked vegetables and fruits. You can also try sprinkling 1 to 2 tablespoons of unprocessed bran to your foods. This helps add bulk that can stimulate bowel movements. A dietician can provide you with additional suggestions on how you can increase the fiber in your diet.
- If you are physically able, try to walk or engage in some form of exercise. This helps stimulate bowel activity called peristalsis that moves matter through the intestines.
- Try to drink at least eight to 10 glasses of fluid daily. This increases the fluid level in the digestive tract and helps keep stool soft.
- Try to set aside time for a bowel movement at the same time each day. It is usually best to do this after a meal and when you will not be rushed or interrupted. It may also help to drink something hot about 30 minutes before your planned bowel movement.
- Eat foods that have eased your constipation in the past.
- You should always heed nature’s call for a bowel movement. You can induce or even worsen constipation if you try to hold in a bowel movement when you feel the urge.
After consulting your doctor, you can even try a laxative. You should never start taking laxatives or stool softeners without checking with your doctor first. There are also new medications available specifically to treat opioid-induced constipation.
How Can I Prevent Nausea and Vomiting?
In most cases, the nausea and vomiting associated with narcotics will go away within a few days. You can also try the following to relieve your symptoms:
- If you feel nauseous when walking around, try staying in bed for about an hour after taking your medicine. The nausea is similar to motion sickness. Your doctor may also recommend over-the-counter remedies – you should not take these medications with consulting your nurse, pharmacist, or doctor.
- Pain can also cause nausea. If this is the case, your nausea should go away as your pain improves. You should let your doctor know if you experience continued or breakthrough pain so that they can adjust your medication regimen.
- Ask your doctor if your nausea could be related to another condition or medication such as anticancer drugs, steroids, or aspirin.
Nausea and vomiting alone do not necessarily mean you are allergic to the narcotic. In most cases of an allergic reaction, the nausea and vomiting will be accompanied by a rash and itching. If you experience these symptoms, you should stop taking the medication immediately and contact your medical provider.
Will I Require Shots If My Pain Becomes Severe?
It is common to have to change medication delivery methods as your treatment and pain changes; however, Injections, or shots, are not typically used to treat pain. New ways of giving narcotic pain relievers are being developed every day and proving useful in controlling pain. For example, morphine tablets are now available in a long-acting formula that may help in cases where standard tablets do not provide relief long enough. Other narcotics are available in fast-acting sublingual tablets that dissolve under the tongue. Some narcoties can come in patch form that delivers continuous pain medication for up to 72 hours. These patches have been shown to be effective in reducing breakthrough pain. If pills, patches, or suppositories do not give you effective pain relief, your doctor may recommend intravenous medication.
A popular form of intravenous pain medication is called patient-controlled analgesia, or PCA. The medication is delivered by means of a computerized pump that delivers a preset amount of medication whenever the patient pushes a button. PCA is not recommended for individuals who do not have the mental or physical capacity to push the button themselves. Another new method of pain management is continuous subcutaneous infusion. With this method, a small pump automatically delivers the drug through a needle implanted just under the skin. In some instances, doctors may resort to spinal anesthesia.
Doctors can administer pain medication epidurally into the space surrounding the spinal cord or intrathecally by injecting the medication directly into the spinal cord. Your doctor can provide you with more information about new methods of pain treatment and if they would be beneficial to you or your loved one.
Are There Other Prescription Drugs Available To Treat Cancer Pain?
There are several classes of non-narcotic prescription medications that can be used instead of or in conjunction with narcotics to treat cancer pain. Some of these medications have pain-relieving qualities of their own, and others increase or potentiate the pain-relieving action of the narcotic. Still other medications reduce the side effects of the narcotics. The following are examples of non-narcotic drugs that your doctor may use to help you achieve optimal pain relief.
- Antidepressants are frequently beneficial in treating pain related to radiation therapy, surgery, or chemotherapy.
- Antihistamines can be effective in controlling nausea, reducing pain, and inducing sleep.
- Severe pain is often accompanied by muscle spasms. Antianxiety medications help relax muscles to relieve these spasms. They may also reduce the anxiety experienced by some cancer patients.
- Anticonvulsants, are helpful in treating pain caused by nerve injury related to cancer and cancer therapy.
- Steroids, which have anti-inflammatory properties, are often effective in treating acute and chronic cancer pain. Frequently used steroids include Decadron and prednisone.
- Motrin and other NSAIDs can relieve pain and inflammation from surgery and bone metastasis.
Every Patient is Different
There is not a “one size fits all” formula for treating pain caused by a life-limiting or chronic illness. The first step in creating an effective pain management regimen is to have a conversation with your doctor or a specialist in the treatment of pain. By working together, you and your doctor can determine the right medications to help you meet your pain management goals. It is also important to remember that effective pain management requires re-evaluation and modification as your disease and treatment progresses.