Opioids

There are different types of opioid painkillers. The type and dose you take depends on how severe your pain is. You can take opioid painkillers for mild, moderate and severe pain. 

When you might have them

Opioid painkillers are a common treatment for cancer pain. The type you have depends on what kind of pain you have and how much pain you are in.

Opioids

Opioids for mild to moderate pain include codeine. Some types are available over the counter.

Opioids for severe pain include:

  • morphine
  • oxycodone
  • diamorphine
  • fentanyl and alfentanil
  • buprenorphine
  • hydromorphone
  • methadone
  • tramadol

You can only get these drugs on prescription from your doctor. 

Side effects of opioids

The most common side effects of opioid drugs are:

  • constipation
  • feeling or being sick

The side effects are different for everyone. They can depend on the type of drug and the dose.

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

We have more detailed information about opioid drugs, how you have them and any possible side effects you might have.

Worries about addiction

You might worry that you will become addicted to morphine and other opioid drugs. This is a common fear. But it’s unlikely that you’ll get addicted to painkillers if you’re taking them for cancer pain.

Doctors usually start you on a weaker opioid and then move on to a stronger one if needed. They will increase the dose slowly until your pain is better controlled. 

Sometimes, you might need very high dose of these drugs to control your pain. It is quite safe to take high doses if you need them to feel comfortable. Your nurse and doctor will keep a close watch for side effects. 

Your doctor might prescribe you non opioid drugs to take alongside opioids. This is to give you the best pain relief possible.

Morphine

There are lots of different preparations of morphine that you can take in different ways. They include:

  • an immediate release liquid or capsule that you take every 2 to 4 hours
  • slow release tablets, or powder that you take every 12 hours
  • a liquid that can be injected into a vein or given through a drip (intravenous)
  • a liquid that can be given through a small needle under the skin (subcutaneous)
  • tablets you dissolve under your tongue (transmucosal tablets)
  • patches you stick on to the skin (transdermal patches)

When you start taking morphine, you normally have the more short acting, immediate release type. One example of this is called Oramorph. You might take it every 2 to 4 hours. That way your medical team can adjust your dose quickly and easily until your pain is controlled. Your doctor or nurse will give you instructions on how much morphine to take and when to take it. There is some flexibility so that you can take enough to control your pain.

Your pain might come back between morphine doses if the dose you start off with isn’t enough. It’s important to keep a note of how much morphine you take and when. Then your doctor or nurse can work out how much you need every 24 hours.

Once your doctor or nurse know how much morphine you need to control your pain, they can give you slow release tablets containing enough morphine to control your pain for 12 or 24 hours.

There are several types of slow release tablets. They’re also called sustained release morphine. The tablet releases the morphine slowly and it controls your pain for long periods. This is more convenient than taking tablets every 4 hours. 

Examples of longer acting morphine drugs are:

  • Zomoroph
  • MST
Remember that you must take slow release tablets regularly or they won't work. When you start taking them, it can take up to 48 hours for the dose to steady in your bloodstream. They are not the sort of tablets that you can take now and again.

You should also have a supply of the immediate release type morphine. You take this in case you have any extra pain while you are taking slow release tablets.

The extra pain may be breakthrough pain or incident pain. Breakthrough pain happens when the medicines you’re taking are not controlling your pain. Incident pain is the type of pain that comes on quickly, for example when you need to have a dressing changed or move around. 

Keep a note of what you take so that you can tell your doctor and nurse. If you frequently need extra doses, you may need a higher dose of the slow acting tablets.

With morphine, you often have other drugs that help to reduce pain. For example, you might also have an anti inflammatory drug to help reduce inflammation that is adding to the pressure the cancer causes.

Oxycodone

This opioid is a man made (synthetic) form of morphine. It’s helpful particularly if morphine hasn’t helped or has given you unpleasant side effects.

Oxycodone is still a strong opioid and works in a similar way to morphine. It is available as:

  • an injectable liquid
  • a liquid that you drink
  • tablets or capsules to swallow

There are slow release tablets for example:

  • OxyContin
  • Abtard
  • Leveraxo
  • Longtec

You should have a supply of the immediate release oxycodone called Oxynorm. You take this if you have any extra pain while you’re taking slow release tablets.

Diamorphine

Diamorphine is a form of morphine that’s very easy to dissolve in very small amounts of water.

Doctors might use it when you need to have morphine by injection, especially in a syringe driver. A syringe driver is a small battery operated pump. It gives liquid from a syringe through a small fine tube placed just under the skin.

The pump can give small amounts continuously. So doctors use it when they need to give regular pain control to people who have sickness or find it difficult to swallow tablets.

They might also use the pump for people who are terminally ill, but being cared for at home. A nurse changes the syringe every 12 to 24 hours.

Fentanyl and alfentanil

Fentanyl is a man made (synthetic), slow release opioid.  Alfentanil is a type of fentanyl. It is also called Rapifen.

You can have it as a patch (called Durogesic or Matrifen) which sticks onto your skin and releases the drug slowly. So, you don't have to take any tablets or have any injections. The patch is normally on your upper arm so you can easily reach it.

When you start fentanyl, it can take up to 72 hours to get the right level of drug in your bloodstream. So your doctor asks you to carry on taking your previous painkillers for a while.

While you have a fentanyl patch, you should also have a supply of the immediate release type morphine or oxycodone. This is so you can take it in case you have any extra pain.

After you stop using a fentanyl patch, it takes up to 72 hours to get the fentanyl out of your system. So if you need another painkiller, your doctors will need to phase it in gradually as the fentanyl is phased out. 

Fentanyl is also available as a lolly that you rub inside your mouth. It is called Actiq. It works very quickly and gives fast pain relief. It is helpful for pain that comes on quickly, such as when you need to have a dressing changed or move around.  But you need a moist mouth for it to work, so it’s not helpful for everyone with cancer pain. 

Fentanyl is also available as a tablet that you put between your gum and cheek. It slowly dissolves. The tablets are called Effentora and Abstral. It is also available as a nasal spray called PecFent. The tablet and the nasal spray are for pain that comes on if your usual medicines aren’t controlling your pain (breakthrough pain).

Alfentanil dissolves in water. So doctors might use it if they need to give you fentanyl by injection, especially in a syringe driver. It gives liquid from a syringe through a small fine tube just under the skin.

The pump can give tiny amounts continuously. Doctors use it when they need to give regular pain control to people who have sickness or find it difficult to swallow tablets. They might also use the pump for people who have advanced cancer and are being cared for at home.

Buprenorphine

Buprenorphine is a medium to strong opioid painkiller.

You can have it as stick on patches which you put on every 3 days, called Hapoctasin or Prenotrix.

There are other patches that you change every 4 days, examples of these are:

  • Bupeaze
  • Buplast
  • Relevtec
  • Transtec

And some you change once a week. These include:

  • Butec
  • BuTrans
  • Panitaz
  • Reletrans
  • Sevodyne

They’re useful if you find swallowing pills and medicines difficult.

It takes at least 24 hours for the right level of the drug to build up in your bloodstream. And if you’re using a 7 day patch, it can take up to 3 days.

You might need to continue with your other painkillers during this time. Follow your doctor's advice.

While you have one of these patches, you should also have a supply of the immediate release type morphine or oxycodone. This is for you to take in case you have any extra pain. It takes a few days to get the drug out of your system when you stop taking it.

Buprenorphine is also available as a tablet called Tephine. You dissolve it under your tongue and have it every 6 to 8 hours.

Hydromorphone

Hydromorphone is a strong opioid. It is also called Palladone. It’s available as:

  • immediate release capsules
  • slow release capsules that you take every 12 hours (Palladone SR)
  • an injectable liquid

With slow release tablets, you should also have a supply of the immediate release type hydromorphone. You then take these if you have any extra pain.

Methadone

Methadone is a strong opioid. It works very well at controlling nerve pain. It's available as:

  • tablets
  • a liquid that you swallow
  • an injectable liquid

Codeine

Codeine is a weak opioid. It's usually the first choice of drug if non opioid drugs are not enough to control your pain.

A number of tablets combine codeine and paracetamol, such as co-codamol or co-dydramol.

Tramadol

Tramadol is a weak opioid. It's available as:

  • tablets or capsules (such as Zamadol)
  • slow release tablets or capsules that you take every 12 hours (such as Tramquel or Zeridame)
  • tablets that dissolve on your tongue (Zamadol melt)

While you are taking slow release tablets, you should also have a supply of the immediate release type tramadol. You take this if you have any extra pain.

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