Worries about taking painkillers

Most cancer pain can be relieved in some way. But some things can get in the way of treating pain effectively, including any worries you might have about painkillers. Telling your specialist team about these barriers can help them manage your pain better.

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 might 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 painkillers because they're frightened of side effects.

A common worry about taking strong painkillers like morphine is feeling drowsy. Or not being 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. It may also happen if your doctor has just increased the amount (dose). But this usually only lasts a few days.

In some cases, drowsiness could mean that the dose is too high. Your doctor or palliative care (symptom control) nurse will suggest lowering it. Then, if that affects your pain control, they might suggest changing to another painkiller. Or adding in other types of painkillers to help.

Other side effects can include sickness or constipation. Doctors can usually prevent or relieve these.

Fear of addiction

Addiction is the most common fear about taking strong painkillers, or opioids like morphine. 

It’s rare for people who take prescribed cancer pain drugs to get addicted. Addiction happens because people get a high feeling from a drug and this makes them want to take it again. But when doctors prescribe 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 painkiller. This can happen 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. Withdrawal symptoms might include 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.

Drug tolerance

You might 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 or change you to a different kind of medicine.

You will talk regularly about your pain so the doctor can work out if you are having the right amount. For example, you might need a higher dose of your painkillers or other drugs if your cancer is growing. 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 or weeks.

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 will 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 and pain relief

Although it’s rare now, some healthcare professionals might not think it’s good to take a lot of painkiller. These are usually people that aren't trained in cancer care or pain. 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.

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.

Worries about talking about pain

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 as you would 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 or palliative care specialist doctor or nurse to help you.