In this information, we use the general (generic) name of each drug, rather than the brand name.
There are different types of opioid painkillers, including weaker and stronger opioids. They may be taken in different ways, and have different side effects. You may take them with other types of pain relief. The type of painkiller you have will depend on what kind of pain you have, and your general health.
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. If you still have pain, tell your doctor or nurse so that they can change the dose or painkiller.
If weaker opioids do not control your pain, you may have a stronger opioid. Your doctor or nurse will work out the best dose for you that manages your pain, without causing bad side effects. 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.
Stronger opioids include morphine, oxycodone, fentanyl, buprenorphine, methadone and tapentadol.
Some stronger opioids are available in two forms:
- fast acting opioids, which are also called immediate release
- long acting opioids, which are also called slow or modified release.
Fast acting opioids
Fast acting opioids (immediate release) 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 a fast acting opioid.
Long acting opioids
You usually take a long acting opioid (modified release) twice a day to control background pain. These opioids take longer to have the full effect. So you must take them regularly at the same time of day for them to work properly. Sometimes you may take a fast acting dose and a long acting dose at the same time. This will give you pain relief straight away, followed by the effect of the long acting medicine.