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Barriers to treating pain

Coping with cancer

This page tells you about things that can be a barrier to treating pain effectively. There is information about

 

Not wanting to take painkillers

Most cancer pain can be relieved in some way but there can still be problems. You may not want to take painkillers because

  • You are frightened of having side effects from the drugs
  • You are frightened that you will get addicted to the drugs
  • You worry that you will get used to the drug and need more and more
  • You feel that taking painkillers is giving up and not fighting the cancer

Or you may not get good pain relief because

  • You may need to see someone who specialises in pain
  • Your pain has not yet been properly assessed
 

Fear of side effects

Some people are worried about taking prescribed doses of painkillers because they are frightened of side effects. One 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 and you may think that you'd rather be in pain than get too sleepy or fuzzy minded to do everyday things. 

You may 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 may mean that the dose is too high and your doctor or symptom control nurse will suggest lowering it. If your pain is not controlled, they may suggest changing to another type of painkiller or adding in other types of painkillers. Other side effects such as sickness or constipation can usually be prevented or relieved. There is information about controlling side effects of painkillers in this section.

 

Fear of addiction

The most common fear with morphine type painkillers (opioids) is that you will get addicted to them. But it is rare for people who take cancer pain drugs prescribed by their doctors to get addicted. Addiction begins because people get a high feeling from the drug which makes them want to take it again. When painkillers are prescribed properly for pain control most people don't get a psychological high and so won't get addicted.

Your body can adapt to having morphine type painkillers, particularly if you are taking high doses for a long period of time. This is called physical dependence. It is not addiction. It means that if you stop taking the painkiller suddenly you may develop withdrawal symptoms, such as cramps, sweating and diarrhoea. Doctors and nurses usually avoid this from happening by gradually reducing the dose of your painkillers.

Even if you know that most people with cancer don't get addicted to the painkillers, your relatives might worry that you will. They may encourage you not to take your pain relief. If this happens it may be helpful to get your doctor or specialist nurse to speak to your relatives and reassure them.

 

Drug tolerance

You may hear the term drug tolerance. This means that over time your body gets used to a drug 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 you will need to increase or decrease your painkiller dose as the pain gets better or worse.

Sometimes pain may increase due to a cancer growing and then the dose of painkiller may need to be increased. Let your doctor or nurse know if you start to feel pain before you are due for your next dose of drugs. You may need to increase the dose of the painkillers you are having or add other drugs to help relieve your pain. Increasing the dose of morphine type painkillers to help with increasing pain or drug tolerance will not lead to addiction.

If your pain lessens, for example because of cancer treatment shrinking a tumour, your doctor or nurse will 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 may worry that it is the beginning of the end. You may 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. If your pain is well controlled, you are more likely to be able to deal with other aspects of your illness.

Pain is also easier to control if it is treated quickly. If you have pain for a while, it can cause changes in the nerves which make the pain very difficult to control. So it is important that pain is treated as soon as possible. Don't feel that you have to be brave and put up with pain. If your pain is well controlled you will have a much better quality of life and will be able to achieve much more.

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

People with cancer are not the only ones who have fears about pain relief. Although it is rare now, some doctors and nurses not trained in cancer care or pain may believe that it is not a good thing to take too many painkillers. They may also have misunderstandings about addiction. But more health professionals are now trained in pain relief and can pass on that knowledge to their colleagues. The National Institute for Health and Care Excellence (NICE) have issued guidance which will also help health professionals 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 are concerned that your doctor or nurse may not be treating your pain properly, you can ask to be referred to the doctor at your local hospice or to a specialist pain clinic for some expert advice.

 

Poor pain assessment

Sometimes pain can go untreated if you feel you can't mention it because your medical team have not asked you about it. You may think you should put up with the pain. Or that you are complaining too much if you talk about being in pain. You may worry that the pain means your cancer is getting worse. You may worry about saying anything or asking questions because you don't really want to hear the answers.

It is important for doctors, nurses and patients to talk about pain. If your pain is properly assessed, it is more likely to be well controlled. Don't feel as though you are complaining. If you let your doctors and nurses know how you feel, they can help to control the pain. They want to help you feel better.

If the pain is very difficult to control, you can be referred to a pain specialist doctor or nurse to help sort it out.

There is information about pain assessment in this section.

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Updated: 3 July 2013