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1 •
Is it true that when my doctor orders morphine for my pain, that it means the end is near?
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No. Morphine is an opioid medication and opioids are a mainstay medication in managing cancer pain.
It is often prescribed for cancer pain at any stage of disease. Pain levels are not directly linked to the severity of
your cancer or to mortality.
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2 •
I've heard that the side effects of opioids are worse than the cancer pain they treat. Is this true?
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Opioids have side effects that can be troubling, especially if a person taking them is not aware of likely
side effects and has not been instructed on how they can be managed. Almost all people taking opioids will need to
cope with constipation, for example, and it is recommended that a bowel regimen to fight constipation begin at the
same time a person starts taking the drug, rather than waiting until constipation has become a fact of life. Other side
effects, like drowsiness and mild nausea, usually fade away after a few days, but there are also solutions to these
problems available if you are uncomfortable. Knowledge and preparation are the key. Ask your health care provider
specifically for assistance in managing side effects of opioids.
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3 • I'm afraid that if I use strong pain medicine now, there won't be anything left to treat my pain later, when it gets worse.
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Pain medications don't work like this. Opioids used by themselves do NOT have a "ceiling" dose, meaning
a level beyond which no more medication can be given. And if one opioid becomes less than satisfactory in
providing pain relief, others may be used, as well as other medications and techniques for pain relief. There is
ALWAYS more that can be done to ease your pain. Don't deprive yourself of your pain medication because you
fear nothing can help later. It just isn't true.
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4 • I've heard that pain medicines will make me sleepy all the time. Is this true?
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No. It is true that some people experience drowsiness when they begin taking opioid medications, but this
usually goes away after a few days, after the body adjusts to the medication. If drowsiness becomes a problem
during these first days, try caffeinated drinks or speak with your health care provider about other medications that
can counteract the drowsiness. If drowsiness persists after several days or if you're having trouble remaining
awake even when you're fully engaged in conversation or activity, call your physician for assistance.
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5 • How can I avoid becoming addicted to my pain medicine?
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As is discussed elsewhere on this site, people who take opioid medications for cancer pain relief are not
"addicted." Addiction is a psychological need for drugs. Pain relief is a physical need, and that makes an enormous
difference in this situation. When you no longer need your opioid pain medication, your physician or nurse will help
you slowly reduce the amount you are using, all the way to zero, and you will not want to take this medication any
more. See the section on "The Myth of Addiction"
for more information.
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6 • I've tried some drugs for my pain and they haven't really worked well. Is there anything left for me to try?
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There are always more options for pain relief. What medications to try next will depend on the kind of
pain you have, what medications you've tried that haven't helped enough, and so forth. Seek assistance from your
health care provider for your pain, and, if necessary, ask for and work with a pain specialist to find the right
combination of medications and other techniques for your situation.
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7 • My doctor told me that there is nothing else he can do for my pain. Now what?
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You need to find another physician or a pain specialist (a physician or nurse who specializes in pain
management). There is ALWAYS more that can be done to manage your pain. Never accept the statement that
"nothing more can be done" for pain. Insist on the help you need to find relief.
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8 • I can't seem to get on a good schedule for pain medications. I'm supposed to take my pill every four hours, but sometimes the pain is back before it's time to take the next pill. What should I do?
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Your schedule of medication sounds like it is being administered on an around-the-clock basis, which is a
good choice for people with pain that is expected to continue or recur. However, the medication you are using does
not sound like it is providing sufficient relief in the dosage you take now. It's likely that a change is needed, so
speak with your physician and ask for a medication that works more effectively.
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9 • I've been told to take my pain medication whenever I need it but sometimes that means I'm in pain for an hour or more before any relief begins. Is there a better way?
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For cancer pain that is constant, or expected to recur, the best method of administration is to take the
medication on an around-the-clock, scheduled way, such as a tablet every 6 hours. This means that you'll have a
steady level of medication in your bloodstream, which will help avoid the situation you describe.
If you are not experiencing constant or frequently-recurring pain, then it might be helpful to think about
activities that appear to trigger your pain, such as walking or riding in a car, for example. If there is a link between
the pain and something you do, then you can arrange to take the medication in sufficient time to have sufficient
relief in place when you undertake the activity.
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10 • I take my pain medications on an around-the-clock basis, but at times I have pain anyway. What can I do about this?
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The pain you experience is called breakthrough pain, and you probably need a medication to handle that
kind of pain, as well as the pain your around-the-clock medications are designed to ease. Breakthrough pain can
occur for no obvious reason, or as the result of some activity that seems to trigger it, such as walking, coughing, etc.
Regardless of the reason, it's likely that you'll need an additional medication to use during these times. See the
section called "Breakthrough Pain" for more information.
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11 • Sometimes I've had difficulty in finding a pharmacy willing to fill my pain medication prescription. What can I do?
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Some pharmacies are reluctant to stock opioid medications, because of a variety of concerns. Speak with
your health care provider or your hospital social worker or pharmacist to learn the names of pharmacies that stock
the medication you need and arrange to have your prescriptions filled there.
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12 • I don't have health insurance that covers my prescription medications for pain, and I can't afford to pay for them. Is there any way to get help with this?
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Yes. Many pharmaceutical companies have programs to provide prescription medications to patients who
cannot afford to pain for them. Most programs require your physician to make the contact regarding the medication.
There are two web sites that list companies who offer this assistance:
http://pain.com/top/top_drugassistanceprogram.cfm
http://www.phrma.org/patients/index.html
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13 • I take pain medications around the clock, and sometimes this means I have to wake myself up several times during the night to take a pill. Can this be handled differently?
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Yes, very probably. It may be possible for your health care provider to switch you to a different form of
your medication or to a different medication that is longer-lasting, one that will allow you to sleep through the night.
Speak with your physician about ways to solve this. Your sleep is very important to all aspects of cancer
management, including pain management.
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14 • I'd like to learn more about the pain medications I use. Where can I find information about them?
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The web site of the Pharmaceutical Manufacturers Association has a listing of more than 500 prescription
medications on its Internet Drug List, found at
http://www.rxlist.com.
The site also has information about non- prescription medications. Additionally, the U.S. Food and Drug Administration has a great deal of information
available on its web site at
http://www.fda.gov.
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15 • My wife thinks I am taking too much pain medication and sometimes tries to persuade me to take less. I don't know what to tell her.
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It's likely that your wife doesn't know the facts about how cancer pain medications like opioids really
work, and she is concerned for your well-being. It might be useful to have her read
some sections of this web site including the caregiver's guide
herself, so she can learn that it is important for you to take sufficient medication to relieve your pain, and enjoy a
good quality of life. You may also encourage her to speak about her concerns with your physician, oncology nurse
or pain specialist.
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