Opioid painkillers for pancreatic cancer
There are different types of opioid painkillers, including weaker and stronger opioids. They may be taken in different ways, and have different side effects. The type of painkiller you have will depend on what kind of pain you have, and your general health.
If your pain gets worse tell your doctor or nurse. They will look at your painkillers again. It’s normal for doctors to change the dose of painkillers. For example, they may increase the dose of your painkiller or add different drugs. If you have bad side effects, they may offer you a different painkiller.
If you have been taking opioids for a long time, you must not stop taking them suddenly. This can cause severe symptoms like stomach pains, sickness and feeling worried or restless. Your doctor or nurse will help you to slowly reduce the dose so that you don’t get these symptoms.
Weaker opioids include codeine, dihydrocodeine and tramadol. You may have a weaker opioid if your pain isn’t controlled by paracetamol or NSAIDs.
You may take a weaker opioid on its own, or with other drugs, including non-opioid painkillers. If this pain relief is not helping tell your doctor or nurse so that they can increase the dose, or give you a different or stronger painkiller.
If weaker opioids do not control your pain, you may have a stronger opioid. You will usually start on a lower dose of a stronger opioid. The dose can be increased, so let your doctor or nurse know if you still have any pain.
Your doctor or nurse will work out the best dose for you that manages your pain, without causing bad side effects.
Some stronger opioids are available in two forms:
- immediate release opioids, which are also called fast acting
- modified release opioids, which are also called long acting or slow release.
Immediate release opioids start to work after about 20 minutes and reach full effect after about an hour. This makes them good for treating breakthrough pain or sudden changes in pain.
You may start off with an immediate release opioid while your doctor or nurse works out the best dose of a modified release opioid for you.
It can be useful to keep a record of when you take your painkillers so you know when to take your next dose. You can use the pain medicines record card for this.
You usually take a modified release opioid twice a day to control background pain. These opioids take a longer amount of time to have their full effect. So you must take them regularly at the same time of day for them to work properly.
Morphine is usually the strong opioid that people start with. There are two types – immediate release morphine and modified release morphine.
You usually take morphine by mouth, as a tablet or liquid. But you can have it as an injection if you are being sick or have trouble swallowing. Morphine can also be given by a syringe driver.
This drug works in a similar way to morphine and comes in immediate release and modified release forms. You may have oxycodone if morphine causes side effects.
You usually take oxycodone by mouth as a tablet, capsule or liquid. You can also have it as an injection, or by a syringe driver.
This type of opioid painkiller can be a good choice for people who find it hard to swallow tablets, or who can’t take morphine. There are a few types of fentanyl, including injections and skin patches.
Fentanyl patches are used for controlling stable background pain and are usually changed every three days. The patches don’t control unstable or short-term pain.
Fentanyl also comes as tablets which dissolve under your tongue, lozenges that you suck, and nose sprays. These can treat breakthrough pain, and may be used with other painkillers.
This is another option for people who have stable pain and who find it difficult to swallow tablets. Buprenorphine is available as a skin patch, or as a tablet that you dissolve under your tongue.
Methadone can be taken by mouth as a liquid, tablet or capsule. You can also have it as an injection.
Methadone works for different lengths of time in different people, so the dose will be specific to you. It may only be offered by doctors who have a lot of experience in using it.
More information on pain and pancreatic cancer
Updated February 2019
To be reviewed February 2021