Opioid Pain Management: Common Misconceptions and Barriers

Opioids are a class of medications often prescribed for cancer pain. When taken properly, opioids are a very effective and safe pain medication. Unfortunately, there has been widespread misuse with this class of medications, and they should only be used as directed and under the guidance of your care team.

Because of the complexity of pain medications and cancer care, it is important to let your team know all medications you are taking, even if they are prescribed from different providers. Pain medications may affect people differently and the type of medications you are prescribed for pain may vary from others. Below are the answers to some common questions about opioid pain medication. 

Why Am I Being Prescribed Opioids?   

Not everyone needs opioids for pain management. Often one or a combination of acetaminophen and ibuprofen are enough to manage pain. However, sometimes cancer pain is more complex and not well controlled with these medications. In these instances, opioids may be needed to effectively manage pain and reduce suffering.

If taken as prescribed and under the guidance of your provider, associated risks of using pain meds (such as impairment, addiction, etc.) can be reduced. Your provider may combine other pain management strategies with your opioids to manage your symptoms. This may include muscle relaxers, medications for nerve type pain, physical therapy, or acupuncture. 

My Dose Increased. Does This Mean I Am Becoming Addicted? 

Increases in your opioid dose does not mean that you are addicted to your medication. Tolerance is the body’s adaptation to continued exposure to a medication whereas addiction and dependence is a physical and psychological need to have a medication.

With opioid medications, your body may develop a tolerance due to prolonged use and dosages may need to be changed. Risk factors for addiction can include some psychiatric disorders, history/active drug abuse, history/active alcohol abuse, and/or family history of addiction. It is important to discuss options with your medical doctor if you feel you are at risk.  

Will Pain Medications Fix the Cause of My Pain? 

The management of cancer pain can be complex since the experience of pain is multifaceted. Pain is not only a physical experience but can be one affected by sensory, behavior, spiritual needs, etc. The initial goal of your pain management plan may be to provide you with relief while addressing the root cause of your pain.

Sometimes by achieving this pain relief, your provider can identify or better manage the cause or causes of your pain. (e.g., surgery may be required to remove a growth causing pressure/pain). Additional therapies such as radiation, physical therapy, and depression management may be used in conjunction with opioids to meet your pain needs.  

Will My Provider Think I Am a "Drug Seeker" If I Ask for Pain Medications? 

A request for pain medications or a referral to palliative care/pain management is common for cancer patients. Your provider should always be willing to discuss management of any new or ongoing pain. You should never feel like you are “bothering” your provider; their goal is to ensure your comfort throughout your cancer care.  

Pro Tip: Keep a journal of the pain intensity, location, and type to bring to your appointments. 

Does Opioid Medication Have Long-Term Effects? 

There are some long-term risks associated with taking opioids such as osteoporosis, mood changes, libido changes, and addiction. When prescribing your medications, your provider will review any risks associated with the medications you are being ordered. Ask as many questions as necessary to ensure you are comfortable with the pain management plan developed for you.

If at any point you begin to experience side effects from your pain medication, please let your care team know. There may be alternative drugs that can be prescribed to continue managing your pain.  

What Side Effects are Most Common with Opioid Medications? 

Constipation is a key side effect that most patients experience when on long-term pain medication. Signs of constipation can include less than three bowel movements a week, abdominal bloating, nausea, hard or “lumpy” stools, etc. If not managed properly, constipation can become a medical emergency.

Communication with your care team regarding any of these signs is important. Almost all patients should be prescribed a bowel regimen for constipation when taking opioids to help prevent this side effect. 

Sedation or “mental cloudiness” is another common side effect of opioid medications, especially when starting a new medication or with dose increases. Signs of sedation can include increased fatigue, difficulty concentrating, memory impairment, confusion, etc. Changes to your pain medication regimen may be needed if these are continued side effects. 

Pro Tip: If you have any questions regarding a bowel regimen or any side effects you may be experiencing, our Iris Nurses are available 24/7 to help.  

What Should I Do If I Cannot Afford My Medications? 

Depending on the type of insurance you have, pain medication/treatment may be covered. If you are concerned about your out-of-pocket cost/copay, request to speak with a social worker.

There are many programs available nationwide (like GoodRx) to help oncology patients with medication costs. Alternatively, you can talk with your provider about other medications with reduced cost that are still effective in managing your pain. 

Talk to your oncology team about any pain you may be experiencing and any goals that you may have for your pain management. You should always feel comfortable discussing your concerns with your team. Our Iris nurses are available 24/7 to discuss any concerns related to pain that you may have.