What Are the Different Kinds of Prescription Pain
For many years, the most widely used prescription pain
relievers have been
. Narcotics are drugs that relieve pain and cause
drowsiness or sleep In addition, they all have similar side
effects. Historically, these drugs came from the opium poppy. They
are also called opioids or
Today, many narcotics are synthetic, that is, they
are chemicals manufactured by drug companies.
Frequently used opioid pain relievers include the
oxycodone (in Percodan)
You can get these pain relievers only with a doctor's written
prescription They may be taken by mouth (orally or PO), by
or IM), through a vein (
or IV), or by rectal suppository. There are
also other methods of giving pain medicines for more continuous
pain relief. Not all narcotics are available in each of these
Another group of prescription pain relievers is similar to
ibuprofen (in large doses, ibuprofen requires a prescription). They
are called nonsteroidal anti-inflammatory drugs (NSAIDs). Included
in this group of pain relievers are Motrin, Naprosyn, Nalfon, and
Trilisate. They are useful for moderate to severe pain. They may be
especially helpful in treating the pain of bone metastasis. Because
NSAlDs are not narcotics, their use does not result in drug
or physical dependence.
These drugs are used alone or with nonprescription pain
relievers to treat moderate to severe pain. Some are more effective
than others in relieving severe pain.
How Do I Decide Which Pain Medications To Use?
This is not something you should decide alone. Discuss this
with your doctor, nurse, or pharmacist before you use any drugs for
pain. Medications that worked for you in the past or that helped a
friend or relative may not be right for you at this time. Never
take someone else's medicine!
Only one doctor should prescribe your pain medicine. If a
consulting doctor changes your medicine, be sure the two doctors
discuss your treatment.
Otherwise, you may take too much or too little.
Let your doctor or nurse know whether your pain medication
gives you relief. Work together to find the medication or
pain-relief program that is best for you. Remember, your need for
pain medicine may change as your cancer treatment changes.
It is important to record the name and amount of pain
medication you take. You can then give precise information to the
doctor or nurse about its effect on your pain.
Will I Become Addicted if I Use Narcotics for Pain Relief?
is defined as dependence on the regular use of
narcotics to satisfy physical, emotional, and psychological needs
rather than for medical reasons. Pain relief is a medical reason
for taking narcotics. Therefore, if you take narcotics to relieve
your pain, you are not an "addict," no matter how much or how often
you take narcotic medicines. If you and your doctor decide that
narcotics are a proper choice for your pain relief, use them as
Addiction is a very common fear of people who take narcotics
for pain relief. Narcotic addiction is an emotionally charged
subject. You may hear people use the term "addiction" very loosely
without understanding exactly what it means-the compulsive use of
habit-forming drugs for their pleasurable effects.
Drug addiction in cancer patients is rare. Generally, when
narcotics are used under proper medical supervision the chance of
addiction is very small. Most patients who take narcotics for pain
relief can stop taking these drugs if their pain can be controlled
by other means. It is important to remember that if narcotics are
the only effective way to relieve pain, the patient's comfort is
more important than any possibility of addiction.
If you take narcotics for several weeks or more, be prepared
for someone to express a concern about addiction. Most people with
prolonged pain who take narcotics have faced this problem. Remind
yourself that other people's concerns about addiction are often due
to lack of information.
If you have concerns about addiction, share them with those who
are caring for you. These fears should not prevent you from using
narcotics to effectively relieve your pain.
What Is Drug Tolerance?
When certain drugs are taken regularly for a length of time,
the body doesn't respond to them as well as it once did, and the
drugs at a fixed dose become less effective. Larger or more
frequent doses must be taken to obtain the effect that was achieved
with the original dose. People who take narcotics for pain control
sometimes find that over time they will need to take larger doses.
This either may be due to an increase in the pain or the
development of drug tolerance. Increasing the doses of narcotics to
relieve increasing pain or to overcome drug tolerance is not
Can Taking Narcotics Be Dangerous?
All medicines can be dangerous if they are not taken properly.
The risks of improperly taking narcotics include overdose, drug
interactions, and accidents resulting from drowsiness.
Too large a dose of a narcotic may cause
breathing to slow down or stop (respiratory depression). Doses
required for good pain relief are rarely, if ever, large enough to
cause death. Doctors carefully adjust the doses of narcotic pain
relievers so that pain is relieved with little effect on breathing.
You may have heard of addicts dying from narcotic overdose. This
usually is due to taking the narcotic with other drugs that
interact with it, or to taking a much higher dose than would be
necessary for pain relief, or to impurities in illegally obtained
narcotics. The first sign of narcotic overdose is a feeling of
unusual sleepiness or difficulty in waking up. If you have either
of these problems, someone should contact your doctor or nurse as
soon as possible.
Combinations of narcotics, alcohol,
and tranquilizers can be dangerous. If you drink alcohol or if you
take tranquilizers, sleeping aids, antidepressants, antihistamines,
or any other drugs that make you sleepy, tell your doctor how much
and how often. Even small doses might cause problems. The use of
alcohol or any of these drugs with narcotics can lead to overdose
symptoms such as weakness, difficulty in breathing, confusion,
anxiety, or more severe drowsiness or dizziness. These drug
interactions may result in unconsciousness and death. Tell your
doctor about any medicine or combination of medicines that makes
you drowsy or sleepy.
Narcotics often cause drowsiness or
dizziness. If you are aware of this, you can be extra careful to
avoid accidents. Sometimes it may be unsafe for you to drive a car
or even to walk up or down stairs. Avoid operating equipment such
as saws or drills, or performing activities that require alertness.
Be aware of the effect narcotics have on you so that you can take
How Much Narcotic Pain Reliever Is Safe for Me To Take?
The amount of pain reliever you take should be determined by
your doctor. Analgesics affect different people in different ways.
A very small dose may be effective for you, while someone else may
need to take a much larger dose to obtain pain relief.
You need to ask these questions:
How much should I take? How often?
If my pain is not relieved, can I take more?
If the dose should be increased, by how much?
Must I call the doctor before increasing the dose?
What if I forget to take it or take it late?
Your doctor will try to prescribe the amount of narcotic that
will be both safe for you and effective for your pain.
Take the medicine as your doctor or nurse has prescribed but
tell them at once if your pain is not controlled or if you have
severe side effects such as extreme drowsiness or difficulty in
breathing. If you do not need as much narcotic as has been
prescribed, your doctor or nurse will tell you how to reduce the
dose or frequency.
What if the Medicine That Has Been
Recommended Doesn't Relieve My Pain?
Tell your doctor or nurse as soon as you can if you are not
getting effective pain relief. Don't wait for your next
appointment! They need to know:
How much, if any, pain relief you get.
How long the pain is relieved.
Any side effects that occur or do not occur, especially
How pain interferes with your normal activities such as sleep,
work, eating, or sex.
With your doctor's help, you can usually get good pain relief.
When the medicine does not give you enough pain relief, the doctor
may increase the dose or the frequency or prescribe a different
drug. Some narcotics are stronger than others, and you may need a
stronger one to control your pain.
If your pain relief is not lasting long enough, ask your doctor
about long acting forms of medicine. Morphine is now available in a
tablet form that releases it over a long period of time (MS Contin
or Roxanol SR).
You may have developed drug tolerance if you have taken
narcotics for a long time. As a result, doses that may have been
too large for you a few weeks before may be safe now. The desired
effect is pain relief with as few side effects as possible,
regardless of the size of the dose.
Some doctors are reluctant to prescribe large enough doses or
stronger narcotics for pain control. However, with careful medical
observation, the doses of strong narcotics (by mouth or injection)
can be safely raised enough to ease severe pain. Do not increase
the dose of your pain medicine on your own.
Remember, you are the best judge of whether your pain is
relieved. If you still have pain and your doctor does not seem to
be aware of other alternatives, ask to see a specialist in cancer
What Are the Side Effects of Narcotics?
Although not everyone has side effects from narcotics, some of
the more common ones are drowsiness, constipation, and nausea and
Some people also might experience dizziness, mental effects
(nightmares, confusion, hallucinations), a moderate decrease in
rate and depth of breathing, or difficulty in urinating.
You should always discuss side effects with your doctor or
nurse. Side effects from narcotic pain relievers can usually be
What Can I Do About Drowsiness?
At first, narcotics cause some drowsiness in most people, but
this usually goes away after a few days. If the narcotic is giving
you pain relief for the first time in a long time, your drowsiness
might be the result of the decrease in pain, allowing you much
needed rest. This kind of drowsiness will go away after you "catch
up" on your sleep. Drowsiness will also lessen as your body gets
used to the medicine. Call your doctor or nurse if you feel you are
too drowsy for your normal activities after you have been taking
the medicine for a week.
If you are drowsy, be very careful to avoid situations in which
you might hurt yourself as a result of not being alert such as
cooking, climbing stairs, or driving.
Here are some ways to handle drowsiness:
Wait a few days and see if it disappears.
Check to see if there are other reasons for the drowsiness. Are
you taking other medicines that can also cause drowsiness?
Ask the doctor if you can take a smaller dose more
If the narcotic is not relieving the pain, the pain itself may
be wearing you out. In this case, better pain relief may result in
less drowsiness. Ask your doctor what you can do to get better pain
Sometimes a small decrease in the dose of a narcotic will still
give you pain relief but no drowsiness. If drowsiness is severe,
you may be taking more narcotic than you need. Ask your doctor
about lowering the amount you are presently taking.
Ask your doctor if you can take a mild stimulant such as
caffeine, or your doctor can prescribe a stimulant such as
dextroamphetamine (Dexedrine) or methylphenidate (Ritalin).
If drowsiness is severe or if it suddenly occurs after you have
been taking narcotics for a while, notify your doctor or nurse
What Can I Do About Constipation?
Narcotics cause constipation in most people. The stool does not
move along the intestinal tract as fast as usual and becomes hard
because more water is absorbed. Your doctor will probably prescribe
a stool softener and a laxative.
After checking with your doctor or nurse, you can try the
Eat foods high in fiber or roughage such as uncooked fruits and
vegetables and whole grain breads and cereals. Adding 1 or 2
tablespoons of unprocessed bran to your food adds bulk and
stimulates bowel movements. Keeping a shaker of bran handy at
mealtimes makes it easy to sprinkle on foods. A dietitian can
suggest other ways to add fiber to your diet.
Drink plenty of liquids. Eight to ten 8-ounce glasses of fluid
each day will help keep your stools soft.
Exercise as much as you are able.
Eat foods that have helped relieve constipation in the
Try to use the toilet or bedside commode when you have a bowel
movement, even if that is the only time you get out of bed.
Plan your bowel movements for the same time each day, if
possible. Set aside time for sitting on the toilet or commode,
preferably after a meal.
Have a hot drink about half an hour before your planned time
for a bowel movement.
If you have difficulty eating enough bran or other foods high
in fiber, check with your doctor, nurse, or pharmacist about using
a bulk laxative such as Metamucil.
Be sure to check with your doctor or nurse before taking any
laxative or stool softener on your own.
What Can I Do for Nausea and Vomiting?
Nausea and vomiting caused by narcotics usually will disappear
after a few days of taking the medicine. The following suggestions
may be helpful:
If your nausea occurs mainly when you are walking around (as
opposed to being in bed), remain in bed for an hour or so after you
take your medicine. This type of nausea is like motion sickness.
Sometimes the doctor will tell you to use medicines (such as Bonine
or Dramamine) that can be bought without a prescription to
counteract this type of nausea. Do not take these medicines without
checking with your doctor, nurse, or pharmacist.
If pain itself is the cause of the nausea, using narcotics to
relieve the pain usually makes this nausea go away.
Medicine (such as Compazine, or Torecan by mouth or by rectal
suppositories) can sometimes be prescribed.
Ask your doctor or nurse if some other medical condition or
other medications you are taking such as steroids, anticancer
drugs, or aspirin might be causing your nausea.
Some people mistakenly think they are allergic to narcotics if
the narcotic causes nausea. Nausea and vomiting alone usually are
not allergic responses. But nausea and vomiting accompanied by a
rash or itching may be an allergic reaction. If this occurs, stop
taking the drug and notify your doctor at once.
I've Heard That Some People Who Stop Taking
Narcotics Have Withdrawal Effects. Is This True?
You should not stop taking narcotic pain relievers suddenly.
People who stop taking narcotic medicine usually are taken off the
drug gradually so that any withdrawal symptoms will be mild or
scarcely noticeable. If you stop taking narcotics suddenly and
develop a flu-like illness, excessive perspiration, diarrhea, or
any other unusual reaction, tell your doctor or nurse. These
symptoms can be treated and tend to disappear in a few days to a
If My Pain Becomes Severe, Will I Need Shots for Pain
Probably not. Intramuscular injections or "shots" are rarely
used for relieving cancer pain. Narcotic rectal suppositories can
be effective, and new methods of giving narcotic pain relievers
have been developed. Long-acting morphine tablets are now
available, and some narcotics provide quick pain relief when they
are given under the tongue (sublingually). One narcotic drug,
fentanyl, is now available as a skin patch which continuously
releases the medicine through the skin for 48 to 72 hours.
If you and your doctor have not been able to find a way to get
good pain control with medicine you take by mouth, some kinds of
pain medicine can be given intravenously. You may want to ask about
patient-controlled analgesia. With this method, a portable
computerized pump containing the medicine is attached to a needle
that is placed in a vein. Whenever pain relief is needed, the
patient presses a button on the pump that delivers a preset dose of
pain medicine into the vein.
A new simple, safe, and effective method of pain control is
continuous subcutaneous infusion
. A small electronic pump
dispenses the drug automatically through a small needle placed
under the skin. Another way of treating cancer pain is to inject
pain medicine into the spinal cord (
) or into the space around the spinal cord
Your doctor or a pain specialist can give you more information
about these advances in pain treatment.
Is It True That Severe Pain Can Only Be Relieved by
No. That is not true. Some newspaper and magazine articles have
suggested that heroin is the only way to relieve severe pain, but
the reported success with heroin was due more to how the drug was
given (in a preventive way) than to the effects of the drug itself.
Strong narcotics such as morphine and Dilaudid usually can relieve
very severe pain. In fact, the body converts heroin to
Heroin is available in England and has been used there to treat
pain in cancer patients. However, even in England, morphine now is
being used routinely because it has been shown to be just as
effective as heroin. In the United States, heroin is not legally
What Other Prescription Medicines Are Used To Relieve Cancer
Several different classes of drugs can be used along with (or
instead of) narcotics to relieve cancer pain. They may have their
own pain-relieving action or they may increase the pain-relieving
activity of narcotics. Others lessen the side effects of narcotic
pain relievers. The following classes of nonnarcotic drugs might be
prescribed by your doctor to help you get the best pain
Antidepressants such as Elavil, Tofranil, or Sinequan are used
to treat the pain that results from surgery, radiation therapy, or
Antihistamines such as Vistaril or Atarax relieve pain, help
control nausea, and help patients sleep.
Antianxiety drugs such as Xanax or Ativan may be used to treat
muscle spasms that often go along with severe pain. In addition
they are helpful for treating the anxiety that some cancer patients
Dextroamphetamine (Dexadrine) increases the pain-relieving
action of narcotic pain relievers and also reduces the drowsiness
Anticonvulsants such as Tegretol or Klonopin are helpful for
pain from nerve injury caused by the cancer or cancer
Steroids such as prednisone or Decadron are useful for some
kinds of both chronic and acute cancer pain.
NSAIDs such as Motrin decrease inflammation and lessen
postsurgical pain and the pain from bone metastases.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a