Some things can get in the way of treating pain effectively, including any worries you might have about painkillers. Knowing about these barriers can help.
Most cancer pain can be relieved in some way, but these are some of the possible barriers.
Not taking painkillers
You might feel you don’t want to take painkillers because:
- you’re frightened of having side effects from the drugs
- you’re frightened of getting addicted to the drugs
- you worry that you will get used to the drug, and need more and more of it
- you feel as though taking painkillers is giving up and not fighting the cancer
Or you might not get good pain relief because:
- you may need to see someone who specialises in pain
- you haven't yet had a proper pain assessment
Fear of side effects
Some people worry about taking prescribed doses of painkillers because they're frightened of side effects.
A common worry for people taking morphine type painkillers (opioids) is a fear of becoming drowsy, or not in control of things. This can be very frightening. You might think that you'd rather be in pain than get too sleepy or fuzzy minded to do everyday things.
You could feel slightly drowsy when you first start taking strong painkillers or if your doctor has just increased the dose. But this usually only lasts a few days.
In some cases, drowsiness could mean that the dose is too high. Your doctor or symptom control nurse will suggest lowering it. Then, if that affects your pain control, they might suggest changing to another type of painkiller or adding in other types of painkillers.
Other side effects can include sickness or constipation. Doctors can usually prevent or relieve these.
Fear of addiction
The most common fear about morphine type painkillers (opioids) is that you will get addicted to them.
But it’s rare for people who take prescribed cancer pain drugs to get addicted. Addiction happens because people get a high feeling from the drug. This makes them want to take it again. But when doctors precribe painkillers properly for pain control, most people don't get a psychological high. So they won't get addicted.
Your body can adapt to having morphine type painkillers, especially if you’re taking high doses for a long time. This is called physical dependence. It is not addiction. It means that if you stop taking the painkiller suddenly, you might develop withdrawal symptoms – such as cramps, sweating and diarrhoea. Doctors and nurses usually avoid this by gradually reducing your painkiller dose.
Even if you know that most people with cancer don't get addicted to the painkillers, your relatives might worry that you will. They might encourage you not to take your pain relief. It could help if you get your doctor or specialist nurse to speak to your relatives and reassure them.
You may hear the term drug tolerance. This means that your body gets used to a drug over time and you need more of it to get the same level of pain control.
Most people taking pain medicines for cancer do not develop this. But if you do, your doctor or nurse may adjust the dose of your painkiller slightly or change you to a different kind of medicine.
Sometimes doctors will also adjust your painkiller dose if your pain gets better or worse. For example, if pain increases due to a cancer growing, doctors might need to increase the dose of your painkillers or add other drugs. Tell your doctor or nurse if you start to feel pain before your next dose of drugs is due.
Increasing the dose of morphine type painkillers to help with increasing pain or drug tolerance will not lead to addiction.
Your pain might also get less - for example, because of cancer treatment shrinking a tumour. Your doctor or nurse will then gradually lower the dose of your painkillers over a few days.
Worry that you are giving up
Some people think that taking painkillers means you have stopped fighting the cancer. You or your family might worry that it is the beginning of the end. You might think that you must be strong and put up with the pain.
This is not true at all. Having constant pain is very draining, both emotionally and physically.
You're more likely to able to deal with other aspects of your illness if your pain is well controlled. You’ll have a much better quality of life and will be able to achieve much more.
Pain is also easier to control if it’s treated quickly. Having pain for a while can cause changes in the nerves which make the pain very difficult to control.
So it’s important that pain is treated as soon as possible. Don't feel that you have to be brave and just accept it.
Taking painkillers does not necessarily mean that you are terminally ill. Many people with chronic pain take strong painkillers for years with no ill effects.
Health professionals not understanding pain relief
Although it’s rare now, some doctors and nurses who aren’t trained in cancer care or pain might not think it’s good to take a lot of painkillers. They might also have misunderstandings about addiction.
But more health professionals are now trained in pain relief. There are also guidelines to help them in controlling severe pain. Many GPs are now experts in controlling cancer symptoms. Some district nurses have extra qualifications in palliative care.
But if you’re concerned, ask your health professional to refer you to the doctor at your local hospice or to a specialist pain clinic for some expert advice.
Poor pain assessment
Sometimes you might feel you shouldn’t mention your pain to your medical team. This could be because:
- your doctor hasn’t asked you about it
- you feel as though you’re complaining
- you’re worried that the cancer is getting worse and you don’t want to ask the doctors - you'd rather not know
But it’s important for your doctors and nurses to be able to assess your pain properly. They want you to feel better, so do tell them about any pain you have. Then they’re more likely to be able to control it.
Even if the pain is very difficult to control, they can refer you to a pain specialist doctor or nurse to help sort it out.