Opioid painkillers for pancreatic cancer
Opioid drugs treat moderate and severe pancreatic cancer pain. You may take them together with non-opioids or other drugs. If your pain gets worse, your medical team may increase the dose or add different drugs. If you have bad side effects, they may offer you a different opioid or non-opioid painkiller.
You usually take opioid painkillers by mouth, as tablets, capsules or as a liquid. If you are having trouble swallowing or are being sick, you may have a tablet or film that dissolves in your mouth, a skin patch, an injection or an infusion into a vein. Another option is a syringe driver, which is a small machine that delivers a steady flow of painkillers under the skin. Speak to your doctor or nurse if you have any problems taking opioid painkillers.
If you have been taking opioids for a long time, don’t stop taking them suddenly. This can cause symptoms like stomach pains, sickness and feeling worried or restless. Your medical team will help you gradually reduce the dose.
Other medicines and alcohol can affect the way your painkillers work or cause side effects, such as sleepiness. Check with your doctor before taking any medicines you’ve bought from the chemist.
The drugs codeine, dihydrocodeine and tramadol are weaker opioids. They treat mild to moderate pancreatic cancer pain at step two of the pain ladder. You may have a weaker opioid or a low dose of a stronger opioid, with or without a non-opioid drug.
Stronger opioids treat moderate to severe pancreatic cancer pain, at step three of the pain ladder.
Some stronger opioids are available in two forms – immediate release opioids and modified release opioids.
Immediate release opioids
Immediate release opioids start to work after about 20 minutes and reach full effect after about an hour. This makes them good for treating very bad pain or breakthrough pain. You may start off with an immediate release opioid while your medical team works out the best dose for you.
Modified release opioids
Modified release opioids take longer to reach their full effect when you first start taking them. You may take a modified release opioid once or twice a day to control stable background pain. You must take them regularly for them to work.
Types of stronger opioid
There are different types of stronger opioid:
- Morphine controls pain well for most people and is usually the first strong opioid that people start with. It’s usually taken by mouth, but you can have an injection or infusion if you are being sick or have trouble swallowing. There are immediate release and modified release forms of morphine.
- Oxycodone issimilar to morphine and comes in immediate release and modified release forms. It’s usually taken by mouth, but you can have it as an injection or infusion. You may have oxycodone if morphine doesn’t suit you or causes side effects.
- Hydromorphone is similar to morphine and comes in immediate release and modified release forms. It’s is available in capsules. If you find it difficult to swallow capsules, you may be able to open them and sprinkle the contents onto a spoonful of cold, soft food. Check this with your doctor as it may affect how well it works.
- Fentanyl can be a good choice for people who find it difficult to swallow or who can’t take morphine. Fentanyl skin patches are used for controlling stable background pain. It also comes as tablets, lozenges, films and nasal sprays for breakthrough pain.
- Buprenorphine is another option for people with stable pain who can’t take drugs by mouth. It comes as a skin patch or a tablet to dissolve under your tongue.
- Methadone can be taken by mouth or as an injection. It works for different lengths of time in different people, and so may only be offered by doctors who have a lot of experience in using it.
- Tapentadol is taken by mouth, normally twice a day. It’s a fairly new painkiller and we need more research to show how well it works – but may work as well as morphine.
Side effects of opioids
Like all medicines, opioids can cause side effects, but you may not get all or any of these. Some side effects settle down within a few days of starting a new drug. Other side effects may last longer. It may not always be clear what’s causing your side effects as pancreatic cancer can cause similar symptoms.
Speak to your medical team about any side effects. They may lower the dose of your painkillers, try a different opioid drug, or another type of pain relief, like a nerve block or radiotherapy.
You can also ask our specialist nurses on our free Support Line about side effects of opioids.
These are some of the common side effects:
- Constipation (problems opening your bowels): This may be less likely with fentanyl and tapentadol than with morphine. Your doctor may give you medicines called laxatives for constipation. If you are taking morphine, start taking the laxative straight away.
- Tiredness: You may feel sleepy when you take a new opioid, or change the dose. Drinking alcohol can make this worse. Don’t drive if you feel sleepy, have just started a new opioid or recently changed the dose. You are legally allowed to drive when taking opioids as long as it doesn’t affect your ability to drive. The Department for Transport has more information.
- Feeling and being sick (nausea and vomiting): This usually gets better after five to ten days, but it can last longer for some people. Your doctor may give you medicine to prevent sickness. Read more about managing sickness.
- Dry mouth: Some people find that drinking plenty of water, sucking ice cubes or chewing gum helps.
Other side effects
Other possible side effects of opioid painkillers include:
- problems sleeping
- mood changes
- sensing things that aren’t there (hallucinations)
- itchy skin
- muscle twitches or jerks.
Speak to your medical team if you have any side effects.
Questions to ask
- What type of painkiller should I take?
- Can you give me written information on how and when I should take painkillers or other drugs?
- What pain relief should I take for breakthrough pain, and how should I use it?
- What side effects might I get?
- Should I take anything to prevent side effects?
- What should I do if the pain doesn’t get better?
Published October 2016
To be reviewed October 2018