Treating moderate to severe pain
Opioids are commonly used when pain is hard to ignore or feels very severe. These drugs need to be prescribed by a doctor. Opioids are not effective for all types of pain. For instance, moderate to severe nerve pain is treated with other types of medicine.
Learn more about:
- Working out the dose
- Opioids commonly used for moderate to severe pain
- Side effects of opioids
- Common questions about opioids
- Other medicines
Opioids are medicines obtained from the opium poppy or created in a laboratory. They work on opioid receptors in the brain and spinal cord to reduce pain. There are many different types of opioids.
Codeine is often used for short periods to manage moderate pain. It is not recommended for long-term or palliative use because it causes constipation. In most cases, codeine is broken down in the body into morphine. However, one in ten people find they don’t get any pain relief as they cannot convert codeine into morphine.
Codeine is often available in combination with other pain medicines, such as paracetamol (e.g. Panadeine Forte) or ibuprofen (e.g Nurofen Plus). If taking one of these stronger combination pain medicines does not offer more relief, let your doctor know as you may need other opioids or a different type of analgesic.
Strong opioids, such as morphine, oxycodone, hydromorphone, methadone and fentanyl, are often effective for moderate to severe pain, and can be used safely if taken as prescribed. Commonly used opioids are listed below. They either release the opioid slowly to control your pain for long periods, or release it quickly to control pain for short periods.
As people respond differently to opioids, the dose is worked out for each person based on their pain level. It’s common to start at a low dose and build up gradually until the pain is well controlled. Sometimes this can be done more quickly in hospital or under strict medical supervision.
Slow release (long-acting)
|Generic name||Brand name|
Immediate release (short-acting)
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This information has been developed by Cancer Council NSW on behalf of all other state and territory Cancer Councils as part of a National Cancer Information Working Group initiative. We thank the reviewers of this information: Dr Tim Hucker, Clinical Lead, Pain Service, Peter MacCallum Cancer Centre, and Lecturer, Monash University, VIC; Carole Arbuckle, 13 11 20 Consultant, Cancer Council Victoria; Anne Burke, Co-Director, Psychology, Central Adelaide Local Health Network, SA, and President Elect, The Australian Pain Society; Kathryn Collins, Co-Director, Psychology, Central Adelaide Local Health Network, SA; A/Prof Roger Goucke, Head, Department of Pain Management, Sir Charles Gairdner Hospital, Director, WA Statewide Pain Service, and Clinical A/Prof, The University of Western Australia, WA; Chris Hayward, Consumer; Prof Melanie Lovell, Senior Staff Specialist, Palliative Care, HammondCare Centre for Learning and Research, Clinical A/Prof, Sydney Medical School, and Adjunct Professor, Faculty of Health, University of Technology Sydney, NSW; Linda Magann, Clinical Nurse Consultant, Palliative Care and Peritonectomy Palliative Care, St George Hospital, NSW; Tara Redemski, Senior Physiotherapist, Gold Coast University Hospital, Southport, QLD.
Thank you to the Australian Adult Cancer Pain Management Guideline Working Party, Improving Palliative Care through Clinical Trials (ImPaCCT), and the Centre for Cardiovascular and Chronic Care (University of Technology Sydney), whose work contributed to the development of the previous editions of this booklet. Thank you also to the original writers, Dr Melanie Lovell and Prof Frances Boyle AM.
View the Cancer Council NSW editorial policy.
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