Opioids for cancer pain relief: Myths and facts

Opioids are medications that can help manage pain caused by cancer and its treatment by
blocking pain signals from injured nerves to the brain. They can help
relieve aching, throbbing pain in the muscles (known as nociceptor
pain), or numbness in the hands and feet known as neuropathy.

We spoke with Dhanalakshmi ("Lakshmi") Koyyalagunta,
about what cancer patients should know about opioids and
myths surrounding them. Here’s what she said.

What are common opioids prescribed to cancer patients?

Some of the most commonly prescribed opioids are tramadol,
hydrocodone, morphine, methadone, hydromorphone, oxycodone,
tapentadol, oxymorphone and fentanyl patches. They vary in strength
and form (pill, elixir, patch or intravenous formulation).

When are opioids prescribed for cancer pain?

We prescribe opioids in the most necessary situations, such as for
patients who have significant pain from their cancer or their
treatment. We use opioids cautiously because of the risk of addiction
and because they’re more easily tolerated over time, which makes them
less effective in managing pain.

When we do prescribe opioids, they’re just one part of our pain
management approach.

What side effects are caused by opioid use?

Patients taking opioids may experience constipation, drowsiness,
nausea, itching, increased sweating, a weakened immune system and
hormonal changes. There’s also the risk of misusing these medications,
which worries many patients.

Here are three myths I commonly hear from patients regarding these drugs.

Myth 1: If I take an opioid for my pain, I’ll get addicted.

Certain factors make a patient more
likely to misuse opioids. Young patients with a history of anxiety,
depression, smoking, drug or alcohol abuse or sexual abuse are more
likely to misuse prescribed opioids. We take several precautions to
ensure these patients won’t fall into abusive behavior.

First, the patient answers the 14-item
Screener and Opioid Assessment for Patients with Pain questionnaire
(known as the SOAPP) that helps identify patients that are at higher
risk of misusing the prescribed opioid. We then educate the patient
and their family about addiction, and we may prescribe an opioid
that’s less likely to be abused, such as patch or tamper-resistant
medication, or a more frequent follow-up appointment schedule. We also
ask about other medications the patient uses since taking
benzodiazepines, like Xanax®, Valium®, and Ambien® for anxiety or
sleep, raises the risk of misuse. Then, we give a small supply of the
medication for a short period of time.

The patient will come in for an
evaluation once the prescription period is done, and we’ll check to
see if the patient took the medicine as prescribed, if it helped
manage the pain and chat about any other concerns they may have
regarding the prescription.

Myth 2: If I experience withdrawal from an opioid, I’m addicted.

Most patients who take an opioid feel
withdrawal symptoms when they stop taking the drug. This is a normal
and isn’t addiction. This may include feeling jittery, sweating,
abdominal pain and heart palpitations. To manage withdrawal symptoms,
we taper off the drug so that the patient takes less over time. Some
patients feel fine early on, but others feel discomfort for two or
three weeks. Withdrawal of opioids is not life-threatening, but it’s
uncomfortable, so we also teach patients how to cope.

Myth 3: If my dosage needs to be increased, it means I’m addicted.

Over time, the body develops a
tolerance for the drug, so it becomes less effective. We can increase
the dosage or, for some patients, we can change the specific
medication prescribed.

Once a dose reaches a level of around
100 mg of morphine, we try a different opioid medication because of
tolerance and also the side effect called opioid-induced hyperalgesia,
which is when opioids can actually make the pain worse. We may also
change your prescription to a different opioid if the other side
effects you experience are affecting your quality of life. But it’s
important to understand that tolerance is physical and addiction is mental.

What are signs of opioid addiction?

Red flags of addiction are craving the medications and using the
drug beyond its prescription, even though the patient know it’s
harmful. Examples of misusing opioids include:

  • taking it for the “high” that you feel while on the
  • taking a larger dose than prescribed (such as
    taking two pills instead of one)
  • taking the drug more
    frequently than prescribed
  • using it with other medications
    that your doctor isn’t aware of
  • mixing it with recreational
    drugs or alcohol

What other steps should patients on opioids take to stay safe?

It’s important that you store your medications securely. We
recommend using a lock box.

Also, only take the drug as prescribed. Don’t share your medication
with anyone else, and don’t take anyone else’s medications.

If you feel your prescription isn’t helping control your pain, talk
with your doctor. We can’t always relieve your pain completely, but we
try our best to make you as comfortable as possible. By including
other therapeutic approaches, such as non-opioid medications, nerve
blocks, other advanced interventions, physical therapy, psychological
support and the cancer treatment itself,  we can help manage the pain
and help you cope with lingering discomfort and get you back to living
your life.

Request an appointment at MD Anderson online or by
calling 1-877-632-6789.