Opioids

Opioid painkillers are a common treatment for cancer pain. There are different types of opioid painkillers. The type and amount (dose) you take depends on how severe your pain is and what  kind of pain you have. You can take opioid painkillers for mild, moderate and severe pain. 

Opioids

Opioids for mild to moderate pain include codeine. Some types are available over the counter.

Opioids for severe pain include:

  • morphine
  • oxycodone
  • diamorphine
  • fentanyl and alfentanil
  • buprenorphine
  • hydromorphone
  • methadone
  • tramadol

You can only get these drugs on prescription from your doctor. 

Side effects of opioids

The most common side effects of opioid drugs are:

  • constipation
  • feeling or being sick

The side effects are different for everyone. They can depend on the type of drug and the dose.

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

We have more detailed information about opioid drugs, how you have them and any possible side effects you might have.

Worries about addiction

You might worry that you will become addicted to morphine and other opioid drugs. This is a common fear. But it’s unlikely that you’ll get addicted to painkillers if you’re taking them for cancer pain.

Doctors usually start you on a weaker opioid and then move on to a stronger one if needed. They will increase the dose slowly until your pain is better controlled. 

Sometimes, you might need very high dose of these drugs to control your pain. It is quite safe to take high doses if you need them to feel comfortable. Your nurse and doctor will keep a close watch for side effects. 

Your doctor might prescribe you non opioid drugs to take alongside opioids. This is to give you the best pain relief possible.

Morphine

There are lots of different preparations of morphine that you can take in different ways. They include:

  • an immediate release liquid or capsule that you take every 2 to 4 hours
  • slow release tablets, or powder that you take every 12 hours
  • a liquid that can be injected into a vein or given through a drip (intravenous)
  • a liquid that can be given through a small needle under the skin (subcutaneous injection)
  • tablets you dissolve under your tongue (transmucosal tablets)

Oxycodone

This opioid is a man made (synthetic) form of morphine. It’s helpful particularly if morphine hasn’t helped or has given you unpleasant side effects.

Oxycodone is still a strong opioid and works in a similar way to morphine. It is available as:

  • an injectable liquid
  • a liquid that you drink
  • tablets or capsules to swallow

There are slow release tablets for example:

  • OxyContin
  • Longtec
  • Oxylan
  • Ixyldone
  • Oxeltra

Some people might have a slow release tablet that is a combination of oxycodone and naloxone. You might have this to prevent the side effect constipation. Examples of these include:

  • Myloxifin
  • Sofonac
  • Targinact

You should have a supply of the immediate release oxycodone one of these is known as Oxynorm. You take this if you have any extra pain while you’re taking slow release tablets.

Diamorphine

Diamorphine is a form of morphine that’s very easy to dissolve in very small amounts of water.

Doctors might use it when you need to have morphine by injection, especially in a syringe driver. A syringe driver is a small battery operated pump. It gives liquid from a syringe through a small fine tube placed just under the skin.

The pump can give small amounts continuously. Doctors use it when they need to give regular pain control to people who have sickness or find it difficult to swallow tablets.

They might also use the pump for people who are terminally ill, but being cared for at home. A nurse changes the syringe every 12 to 24 hours.

Diagram showing a syringe driver

Fentanyl and alfentanil

Fentanyl is a man made (synthetic), slow release opioid.  Alfentanil is a type of fentanyl. It is also called Rapifen.

Buprenorphine

Buprenorphine is a medium to strong opioid painkiller.

You can have it as stick on patches which you put on every 4 days, examples of these are:

  • Bupeaze
  • Carlosafine
  • Relevtec
  • Transtec

And some you change once a week. These include:

  • Butec
  • Bunov
  • BuTrans
  • Panitaz
  • Rebrikel
  • Reletrans
  • Sevodyne

They’re useful if you find swallowing pills and medicines difficult.

Hydromorphone

Hydromorphone is a strong opioid. It is also known as Palladone. It’s available as:

  • immediate release capsules
  • slow release capsules that you take every 12 hours (Palladone SR)
  • an injectable liquid

With slow release tablets, you should also have a supply of the immediate release type hydromorphone. You then take these if you have any extra pain.

Methadone

Methadone is a strong opioid. It works very well at controlling nerve pain. It's available as:

  • tablets
  • a liquid that you swallow
  • an injectable liquid

Codeine

Codeine is a weak opioid. It's usually the first choice of drug if non opioid drugs are not enough to control your pain.

A number of tablets combine codeine and paracetamol, such as co-codamol or co-dydramol.

Tramadol

Tramadol is a weak opioid. It's available as:

  • tablets or capsules (such as Zamadol)
  • slow release tablets or capsules that you take every 12 hours (such as Tramquel or Zeridame)
  • tablets that dissolve on your tongue (Zamadol melt)
  • tablets that you dissolve in water then drink (effervescent tablets)
  • drops that you mix with water and then drink

While you are taking slow release tablets, you should also have a supply of the immediate release type tramadol. You take this if you have any extra pain.

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