- Cancer Information
- Managing side effects
- Pain and cancer
- Treating moderate to severe pain
- Common questions about opioids
Common questions about opioids
Most people have questions about taking opioid medicines. Some common questions that may come up are answered here. Your doctor, nurse practitioner or nurse can also discuss any concerns you have.
If you are caring for someone with cancer pain, you may have some other specific questions about opioids. Check out these answers to common questions from carers.
I found the decision to take morphine really difficult. Having made it, I have been taking the slow release tablets for 18 months with no appreciable side effects. Without the morphine the pain would be too debilitating for me to continue doing all the things I do now.
When people take morphine or other opioids only to relieve acute pain or for palliative care, they are unlikely to become addicted to the medicines. You may experience withdrawal symptoms when you stop taking a drug, but this is not addiction. For this reason, your doctor will reduce your dose gradually. Talk to your doctor if you are concerned about drug dependence.
Taking opioids for pain relief is different to an addiction. Someone with a drug addiction problem takes drugs to satisfy physical or emotional needs, despite the drugs causing harm. A small number of people who take opioids long-term for pain relief are at risk of becoming addicted. The risk is higher for people who have misused medicines in the past.
Will I need to have injections?
Not necessarily. Strong pain relievers are usually given by mouth in either liquid or tablet form. If you’re vomiting, opioids can be given as a suppository inserted into the bottom, by a small injection under the skin (subcutaneously), through a skin patch or in lozenge form. See this list of the different ways medicines are taken.
Opioids can also be injected into a vein for short-term pain relief, such as after surgery. This is called intravenous opioid treatment and it is given in hospital.
If I start opioids too soon, will they be less effective later?
Some people try to avoid taking pain medicine until the pain is severe, thinking it is better to hold out for as long as possible so the medicine works better later. However, this may change the way the central nervous system processes the pain, causing people to experience pain long after the cause of the pain is gone. It is better to take medicine as prescribed rather than just at the time you feel the pain.
If I’m given opioids, does that mean my cancer is advanced?
People with cancer at any stage can develop severe pain that needs to be managed with strong pain medicine, such as morphine. Just because you have to use an opioid, it doesn’t mean you will always need to take it.
If your pain improves, you may be able to take a milder painkiller or you may be able to stop taking pain medicines.
While breakthrough pain is relatively common among people diagnosed with cancer, this sudden flare-up of pain can be distressing.
You might get breakthrough pain even though you’re taking regular doses of medicine. This breakthrough pain may last only a few seconds, several minutes or hours. It can occur if you have been more active than usual or have strained yourself. Other causes of breakthrough pain include anxiety or illnesses such as a cold or urinary tract infection. Sometimes there seems to be no reason for the extra pain.
You need to talk to your health care team, who will advise you on how to cope with breakthrough pain. They will usually suggest you take your pain medicine as well as another drug to help with the breakthrough pain. An extra, or top-up, dose of a short-acting opioid (immediate release opioid) may be prescribed to treat the breakthrough pain. The dose works fairly quickly, in about 30-40 minutes.
It is helpful to keep a record of how many extra doses you need so your doctor can monitor your overall pain management. If you find your pain increases with some activities, taking an extra dose of medicine beforehand may help.
Will the opioids still work if my body gets used to them?
People who have used opioids for a long time will sometimes become tolerant to the original dose. This means that the body stops responding to the drug, and their doctor will need to increase the dose to achieve the same level of pain control. Your dose of opioids may also be increased if your pain gets worse. There is no benefit in saving pain medicines until the pain is severe.
Doctors have a duty to advise patients not to drive if they are a risk to themselves or others. While taking opioids, particularly during the first days of treatment, you may be less alert, so driving is not recommended. Once the dose is stabilised, you may think that it is safe for you to drive, however, using breakthrough pain medicine can affect your driving ability.
Before you start driving again, seek your doctor’s advice and keep the following in mind:
- Don’t drive if you’re tired, you’ve been drinking alcohol, you’re taking other medicine that makes you sleepy, or road conditions are bad.
- It is against the law to drive if your ability to drive safely is influenced by a drug. Also, if you have a car accident while under the influence of a drug, your insurance company may not pay out a claim.
- Special rules and restrictions about driving apply to people with brain tumours, including secondary brain cancer, or people who have had seizures. For more on this, talk to your doctor or download the publication, Assessing Fitness to Drive for commercial and private vehicle drivers, from Austroads.
Can I stop my medicine at any time?
You should only reduce your dose or stop taking opioids in consultation with your health care team. If your pain improves, you may end up needing less or no pain medicine. Morphine and other opioids will need to be decreased gradually to avoid side effects that may occur if you were to stop taking them suddenly. Learn more about withdrawal side effects.
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.
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