Opioids for Cancer Pain | Treatment and Side Effects (2023)

Opioids (narcotics) are used with or without non-opioids to treat moderate to severe pain. They are often a necessary part of a pain relief plan for cancer patients. These medicines are much like natural substances (called endorphins) made by the body to control pain. They were once made from the opium poppy, but today many are man-made in a lab.

Safe use of opioids

Doctors and cancer care teams may prescribe opioids for patients having increasing or severe pain from their cancer or their treatment. Opioids should be prescribed and used with great care for several reasons:

  • Some pain medicines may interfere with other medications.
  • Pain medicines may affect people differently. Because of this, some cannot be given to older adults, young children, or certain people being treated for other medical conditions.
  • The growing concern of what is being called an "opioid epidemic" in the U.S. It's important to remember that opioids can be safely prescribed and used to help control cancer pain.

Your cancer care team will understand any safety concerns you or your loved ones may have about opioids. They also know it's their responsibility to treat your cancer-related pain in the most effective way. Sometimes opioids are needed as part of a pain relief plan.

Because of safety concerns, you will always need a signed, written prescription (not faxed, emailed, or called in) for opioid pain medicines. For this reason, it’s important that only one doctor prescribe your pain medicines. If you have 2 or more doctors, be sure that one does not prescribe opioids for you without talking to the others about it.

Your doctor may ask you and your loved ones questions before prescribing opioids to be sure they will not be used in wrong or unsafe ways. They may ask you who you live with, if children are in the home, how your medications are stored, and other questions. Doctors will also watch you carefully and adjust the doses of pain medicine so you don’t take too much. While taking opioids, you may need to have regular urine or blood tests to check drug levels.

If you drink alcohol or take tranquilizers, sleeping pills, antidepressants, antihistamines, or any other medicines that make you sleepy, your doctor will need to know how much and how often you do this. Taking opioids (even small doses) while drinking alcohol or taking tranquilizers may cause problems and can lead to overdoses and symptoms like weakness, trouble breathing, confusion, anxiety, or more severe drowsiness or dizziness.

(Video) Opioids in Cancer Pain - What you need to know

If you are taking opioids to help relieve your cancer pain, here are some important tips.

  • Store your medications securely, such as in a locked box.
  • Only take the drug as instructed.
  • Don’t share your medication with anyone.

Common opioids used for cancer pain

Here are some of the opioids used in cancer care. Some of the more common brand names are in parentheses.

  • Tramadol (Ultram)
  • Hydromorphone (Dilaudid)
  • Methadone (Dolophine, Methadose)
  • Morphine (Apokyn, Avinza, Kadian, MS-Contin, and others)
  • Oxycodone (OxyContin, OxyIR, Roxicodone)
  • Hydrocodone
  • Oxymorphone (Opana)
  • Fentanyl (Actiq, Duragesic, Fentora, Lazanda, Subsys, and others)
  • Tapentadol (Nucynta)

An “ER” behind the name of any opioid drug names stands for “extended release,” and is a sign that the drug is taken on a regular schedule to treat chronic pain. An “IR” stands for “immediate release” and means that the drug will work quickly and for only a short time. These rapid-onset opioids are used to treat breakthrough pain. Examples of these types of drugs are fast-acting oral morphine; fentanyl in a lozenge, “sucker,” or under-the-tongue spray. (These forms of fentanyl are absorbed from your mouth – they are not swallowed.)

A short-acting opioid, which relieves breakthrough pain quickly, is often used with a long-acting opioid.

Many times the same opioid drug is used to treat both chronic and breakthrough pain. But,it might be prescribed in 2 different pill forms, one that has only the opioid in itand one thatcombines an opioid with a non-opioid. Be sure you know what you’re taking because it's important not tomix them up!

Common opioid and acetaminophen or NSAID drug combinations

See Non-opioids and Other Drugs to Treat Cancer Pain for more on acetaminophen and NSAIDs (non-steroidal anti-inflammatory drugs) like aspirin and ibuprofen.

(Video) Opioids for Cancer Related Pain


Oxycodone may be added to aspirin, acetaminophen, or ibuprofen. For instance:

  • Percodan has aspirin in it
  • Percocet, Roxicet, Roxilox, Oxycet, and Tylox all have acetaminophen
  • Combunox has ibuprofen


Hydrocodone may be added to acetaminophen or ibuprofen. For instance:

  • Vicodin, Zydone, Norco, and Lortab all contain acetaminophen
  • Vicoprofen and Reprexain have ibuprofen

If you’re taking a combination pain medicine, be sure you know what drugs are in each pill.

How to get proper pain relief with opioids

If you feel the drug is not helping to control your pain, talk with your doctor. When a medicine doesn’t give you the pain relief you need, your doctor may prescribe a higher dose or tell you to take it more often. When your cancer care team is working closely with you, doses of strong opioids can be raised safely to ease severe pain. Don’t decide to take more pain medicine on your own. If changing the dose doesn’t work, your doctor may prescribe a different drug or add a new drug to the one you’re taking.

If your pain relief isn’t lasting long enough, ask your doctor about extended-release medicines that come in pills and patches. These can control your pain for a longer period of time.

If your pain is controlled most of the time, but you sometimes have breakthrough pain, your doctor may prescribe a fast-acting medicine or immediate-release opioid that will give you faster pain relief right when it’s needed.

(Video) What are possible side effects of opioids? - Irene Wu, MD | UCLA Pain Center

Opioid tolerance

You might find that over time you need larger doses of pain medicine. This may be because the pain has increased or you have developed a drug tolerance. Drug tolerance occurs when your body gets used to the opioid you’re taking, and it takes more medicine to relieve the pain as well as it once did. Many people do not develop a tolerance to opioids. But if you do develop drug tolerance, usually small increases in the dose or a change in the kind of medicine will help relieve the pain.

Having to increase your dose of opioids to relieve increasing pain or to overcome drug tolerance DOES NOT mean that you are addicted.

Side effects of opioids

Not everyone has side effects from opioids. The most common side effects are usually sleepiness, constipation, nausea, and vomiting. Some people might also have dizziness, itching, mental effects (such as nightmares, confusion, and hallucinations), slow or shallow breathing, or trouble urinating.

Many side effects from opioid pain medicine can be prevented. Some of the mild ones such as nausea, itching, or drowsiness, often go away without treatment after a few days, as your body adjusts to the medicine. Let your doctor or nurse know if you’re having any side effects and ask for help managing them.

Here are a few of the more common side effects:

Drowsiness or sleepiness

When you first start taking them, opioids might make you sleepy, but this usually goes away after a few days. If your pain has kept you from sleeping, you may sleep more for a few days after starting opioids while you “catch up” on your sleep. You also will get less sleepy as your body gets used to the medicine. Call your doctor or nurse if you still feel too sleepy for your normal activities after you’ve been taking the medicine for a week.

(Video) Treating Cancer Pain without Opioids

Sometimes it may be unsafe for you to drive a car, or even to walk up and down stairs alone. Don’t do anything that requires you to be alert until you know how the medicine affects you.

Here are some ways to handle sleepiness:

  • Wait a few days and see if it goes away.
  • Check to see if other medicines you’re taking can also cause sleepiness.
  • Ask the doctor if you can take a smaller dose more often or an extended-release opioid.
  • Ask your doctor what you can do to get better pain relief, if the opioid is not relieving the pain. The pain itself may be tiring you out. In this case, better pain relief may lead to less sleepiness.
  • Ask for a small decrease in the opioid dose. It will still relieve your pain but won’t cause drowsiness. If the drowsiness is very bad, you may be taking more medicine than you need. Talk to your doctor about lowering the amount you’re taking.
  • Ask your doctor about changing to a different medicine.
  • Ask your doctor if you can take a mild stimulant such as caffeine during the day.
  • If drowsiness is bad or if it suddenly starts to be a problem after you’ve been taking opioids for a while, call your doctor or nurse right away.


Opioids cause constipation in most people, but it can often be prevented or controlled. Opioids slow the movement of stool through the intestinal tract, which allows more time for water to be absorbed by the body. The stool then becomes hard. When you start taking opioids, it’s best to take a laxative, stool softener, or other treatment to help keep your stool soft and your bowels moving. For more detailed information on what you can do, see Constipation

Nausea and vomiting

Nausea and vomiting caused by opioids will usually go away after a few days of taking the medicine. For suggestions on handling this side effect, see Nausea and vomiting.

Some people think they’re allergic if they have nausea after they take an opioid. Nausea and vomiting alone usually are not allergic reactions. But a rash or itching along with nausea and vomiting may be an allergic reaction. If this happens, stop taking the medicine and call your doctor right away. If you have swelling in your throat, hives (itchy welts on the skin), or trouble breathing, get help right away.

When you no longer need opioids

You should not stop taking opioids suddenly. People who need or want to stop taking opioids are usually tapered off the medicine slowly so that their bodies have time to adjust to it. If you stop taking opioids suddenly and develop a flu-like illness, excessive sweating, diarrhea, or any other unusual reaction, tell your doctor or nurse. These symptoms can be treated and tend to go away in a few days or weeks. Again, slowly decreasing your opioid dose over time usually keeps these kinds of symptoms from happening. Check with your doctor about the best way to taper off your pain medicines.

(Video) WHO Analgesic Ladder - Pain Management | World Health Organisation Analgesic Ladder (+ Side Effects)


How effective are opioids in cancer pain? ›

In summary, strong opioids are very effective interventions for cancer pain resulting in a 75% response rate and reducing average pain intensity from 6 to 3 on a 0–10 pain scale.

What are the side effects of opioids in cancer patients? ›

There are common side effects caused by opioids.
  • Nausea.
  • Drowsiness.
  • Constipation.
Sep 30, 2022

What is the strongest pain relief for cancer? ›

Opioids are highly effective medicines for relieving cancer pain. These include morphine, fentanyl, codeine, oxycodone, hydromorphone, and methadone. Some people fear the potency of morphine in particular. They believe it is the most powerful opioid.

What drug is the standard opioid for the treatment of cancer pain? ›

- Moderate to severe cancer pain is usually treated with strong opioids, including morphine, oxycodone, fentanyl, hydromorphone and methadone. Morphine is the most commonly used opioid for moderate to severe cancer pain.

Can opioids make cancer worse? ›

Numerous studies suggest that opioids may promote cancer progression. The main mechanisms responsible for this adverse effect include the stimulation of angiogenesis and immunosuppression.

How much oxycodone can you take for cancer pain? ›

This study demonstrates that cancer pain patients given 6 to 12 tablets or capsules of fixed-dose combination analgesics can be equally well treated with CR oxycodone administered every 12 hr or IR oxycodone four times daily at the same total daily dose. CR oxycodone offers the benefits of twice daily dosing.

Why do they give oxycodone to cancer patients? ›

Nearly all patients with malignant tumors suffer pain at the advanced stage of their disease. Oxycodone is a first-line choice for treating moderate-to-severe cancer-related pain, and OxyContin, a controlled-release oxycodone hydrochloride tablet, is internationally recognized as a safe and effective opioid analgesic.

Why are opioids used for cancer pain? ›

Opioids are medications that can help manage pain caused by cancer and its treatment by blocking pain signals from injured nerves to the brain.

What are 3 negative effects opioids have on your body? ›

However, opioids can also have harmful effects, including:
  • drowsiness.
  • confusion.
  • nausea.
  • constipation.
  • euphoria.
  • slowed breathing.
Jun 1, 2021

Which cancer has the worst pain? ›

Primary tumors in the following locations are associated with a relatively high prevalence of pain:
  • Head and neck (67 to 91 percent)
  • Prostate (56 to 94 percent)
  • Uterus (30 to 90 percent)
  • The genitourinary system (58 to 90 percent)
  • Breast (40 to 89 percent)
  • Pancreas (72 to 85 percent)
  • Esophagus (56 to 94 percent)

What to do when cancer pain is unbearable? ›

Anti-inflammatory drugs

“When a tumor invades bone, nerves or organs, it can cause inflammation, which can be painful,” Osuagwu says. Taking a non-steroidal anti-inflammatory drug like Celebrex or meloxicam can offer relief. Ibuprofen and acetaminophen can help treat less severe pain and are available over-the-counter.

What is the most painful of all cancers? ›

Bone cancer is one of the most painful cancers. Factors that drive bone cancer pain evolve and change with disease progression, according to Patrick Mantyh, PhD, symposium speaker and professor of pharmacology, University of Arizona.

What is the gold standard opioid? ›

Opioid Agonist Treatment (OAT): The Gold Standard for Opioid Use Disorder Treatment. Opioid Agonist Treatment (OAT) is the safest and most effective method for treating opioid use disorders.

Are opioids prescribed for cancer? ›

Doctors and cancer care teams may prescribe opioids for patients having increasing or severe pain from their cancer or their treatment. Opioids should be prescribed and used with great care for several reasons: Some pain medicines may interfere with other medications. Pain medicines may affect people differently.

What is the alternative to morphine for cancer pain? ›

Both fentanyl and methadone have some potential advantages over morphine since they are longer-acting and have no active metabolites. However, large doses of fentanyl or long-acting morphine are expensive while methadone has an extremely low cost.

Do opioids cause cancer to spread? ›

The currently available results revealed contradictory conclusions, indicating both positive (opioids through activation of the immune system lead to increased production of pro-inflammatory cytokines) and negative (opioids may induce apoptosis of cancer cells) effects on the cancer development and metastasis.

What is the most life threatening side effect of opioids? ›

The most serious risks include respiratory depression (stopping breathing - also known as “overdose”) resulting in death, and the risk of developing opioid use disorder (from moderate to severe is also known as “addiction”).

Why is cancer so painful? ›

Most cancer pain is caused by the tumour pressing on bones, nerves or other organs in the body. Sometimes pain is due to your cancer treatment. For example, some chemotherapy drugs can cause numbness and tingling in your hands and feet.

What are the side effects of oxycodone for cancer patients? ›

Regarding the adverse effects of high-dose controlled-release oxycodone in cancer patients, the findings of this study showed that side effects were common but not severe and included constipation, nausea, vomiting, and dysuria.

Is morphine or oxycodone better for cancer pain? ›

Morphine or Oxycodone for Moderate to Severe Cancer Pain

“I know the data says morphine might be a little bit better for this; oxycodone might be a little bit better for that,” said Augustin Joseph, MD, attending physician in palliative care at Johns Hopkins University Medical Center.

Can I take 10mg of oxycodone for severe pain? ›

For moderate to severe pain: Adults—10 to 30 milligrams (mg) every 4 hours as needed. Your doctor may adjust your dose as needed. Children—Use and dose must be determined by your doctor.

Should adults with pain from cancer or cancer treatment use opioids? ›

Recommendations: Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated.

What do they give dying cancer patients for pain? ›

In 68% strong opioids were necessary to achieve sufficient pain reduction. Morphine was the most frequently used opioid for 96 patients.

Why do you give opioids for severe pain? ›

Opioids attach to proteins called opioid receptors on nerve cells in the brain, spinal cord, gut, and other parts of the body. When this happens, the opioids block pain messages sent from the body through the spinal cord to the brain.

What is the strongest drug for nerve pain? ›

Tramadol. Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that does not respond to other treatments a GP can prescribe.

What damage do opioids cause? ›

They cause liver damage, especially if you use them along with acetaminophen. And, opioids can affect your breathing. While you're under the influence of opioids, your breathing may slow down so much that your body doesn't get the oxygen it needs. This can cause brain damage.

What is the hardest cancer to fight? ›

Lung & Bronchus

Lung and bronchial cancer causes more deaths in the U.S. than any other type of cancer in both men and women. Although survival rates have increased over the years due to improved treatments, the outlook is still bleak. The five-year survival rate is only 22%.

Which stage of cancer is painful? ›

People with stage IV cancer have the highest degree of cancer pain. Additionally, cancer surgery, treatments, or tests cause cancer pain. Spinal cord compression: When a tumor spreads to the spine, it can press on the nerves of the spinal cord leading to spinal cord compression.

What three cancers are the hardest to treat? ›

Jump to:
  • Lung and bronchial cancer.
  • Pleural cancer.
  • Acute monocytic leukemia.
  • Brain cancer.
  • Acute myeloid leukemia.
  • Why is there no cure?
  • Additional resources.
  • Bibliography.
Sep 21, 2022

Is Stage 4 cancer painful? ›

Symptoms of stage 4 cancer often include pain. The patient's treatment plan should include ways to help him or her be most comfortable, so speak with the care team about any pain and comfort levels. They may be able to provide additional services or refer the patient to specialized palliative care.

Does more pain mean cancer is getting worse? ›

Remember, having more pain does not necessarily mean the cancer is worse or more advanced. You may have pain for a number of reasons. Cancer treatments such as surgery, chemotherapy or radiotherapy can damage body tissue and sometimes nerves, causing you to feel pain. These are physical causes.

How do you live with cancer pain? ›

  1. The pain of cancer is usually constant and needs well-managed relief.
  2. The foundation of cancer pain management is medication, including aspirin-like drugs, paracetamol and opioid drugs.
  3. Helpful relaxation therapies include meditation, massage, tai chi, yoga and hypnotherapy.

What are the hardest cancers to get rid of? ›

Some of the most difficult cancers to treat are those that develop in the:
  • liver.
  • pancreas.
  • ovaries.
  • brain (glioblastomas)
  • cells that give your skin color (melanomas)

What is one of the most aggressive cancers? ›

Lung cancer is the most aggressive form of cancer. Smoking and tobacco use are the major causes of it. Low-dose CT scans, which can detect cancer earlier, have improved survival rates for those with lung cancer, even among heavy smokers.

What are the six least survivable cancers? ›

The LSCT was set up by a group of charities all aiming to double survival rates of the six less survivable cancers by 2029. These are stomach, oesophageal, pancreatic, liver, brain & lung cancer, with an average five-year survival rate of just 16%.

What is the strongest opioid used in hospital? ›

1. About fentanyl. Fentanyl is a strong opioid painkiller. It's used to treat severe pain, for example during or after an operation or a serious injury, or pain from cancer.

What are the names of the 3 types of opioids? ›

Common types are oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone.

What is the new opioid called ISO? ›

Isotonitazene is a potent synthetic opioid, and it is being abused for its opioidergic effects. The abuse of isotonitazene, similar to other synthetic opioids, has been associated with adverse health effects, including numerous deaths.

What are strong opioids for cancer? ›

- Moderate to severe cancer pain is usually treated with strong opioids, including morphine, oxycodone, fentanyl, hydromorphone and methadone. Morphine is the most commonly used opioid for moderate to severe cancer pain.

What is the first line drug for cancer pain? ›

(See "Assessment of cancer pain".) Opioid therapy is the first-line approach for moderate or severe chronic cancer pain. While opioids are effective analgesics, they are potentially abusable drugs.

Do cancer patients take narcotics? ›

People with cancer often need to take strong pain medicine, such as opioids. Ask your health care team about drug tolerance, physical dependence, and addiction, especially if you were prescribed opioids to control pain. Drug tolerance is a condition that happens when your body gets used to medicine.

What is the drug of choice for pain in terminal illness? ›

Opioid drugs are the most effective and commonly used drugs for moderate to severe pain. A wide range of opioid drugs is available, and they can be taken in a variety of ways.

What pain meds are better than morphine? ›

Fentanyl – Pharmaceutical fentanyl is a synthetic opioid, approved for treating severe pain, typically advanced cancer pain. It is 50 to 100 times more potent than morphine.

What pain solution is better than morphine? ›

Ketorolac is slightly more effective than morphine for pain relief during limb motion.

Does oxycodone help cancer related pain? ›

Oxycodone for cancer‐related pain in adults

Oxycodone and morphine are examples of these opioids that are used for the relief of cancer pain. However, strong painkillers are not effective for pain in all people, neither are they well tolerated by all people.

How effective are opioids at treating pain? ›

Key Messages. Opioids are associated with small improvements versus placebo in pain and function, and increased risk of harms at short-term (1 to <6 months) followup; evidence on long-term effectiveness is very limited, and there is evidence of increased risk of serious harms that appear to be dose dependent.

Are strong opioids equally effective and safe in the treatment of chronic cancer pain? ›

Several previous trials have already compared the efficacy and safety of various opioid regimens in patients with chronic cancer pain and have found their analgesic efficacy and safety to be largely similar.

Why is cancer painful at the end? ›

Chronic pain can be due to changes to the nerves. Nerve changes may be due to cancer pressing on nerves or due to chemicals produced by a tumour. It can also be caused by nerve changes due to cancer treatment. Chronic pain continues long after the injury or treatment is over and can range from mild to severe.

What pain relief do they give cancer patients? ›

Doctors usually treat mild to moderate cancer pain with drugs called opioids. These are sometimes called 'morphine-like' medicines. There are different types of opioids and some are stronger than others.

What type of pain do opioids work best on? ›

Prescription opioids (like hydrocodone, oxycodone, and morphine) are one of the many options for treating severe acute pain. While these medications can reduce pain during short-term use, they come with serious risks including addiction and death from overdose when taken for longer periods of time or at high doses.

How long is opioids prescribed for chronic pain? ›

Three days or less will often be sufficient; more than seven days will rarely be needed. Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation.

What are the downsides of opiates for non cancer chronic pain? ›

These side effects include nausea, respiratory depression, acute tolerance and opioid induced hyperalgesia. (Hyperalgesia being defined as an increased response to a stimulus which is normally painful.)

What is the role of opioids in cancer progression? ›

Outside their activity on cancer cells, opioids can promote tumor growth by causing immunosuppression, inflammation, and angiogenesis. NK indicates natural killer. MOR is upregulated in human non–small cell lung cancer (NSCLC) cells and in metastatic nodes.


1. Transdermal opioid formulations for cancer pain- Video abstract 36446
(Dove Medical Press)
2. Morphine - Side Effects
(Med Today)
3. 6. Opioids and chronic non-cancer pain
(NPS MedicineWise)
4. Lunch & Learn: Truth about Opioids & Cancer
(Vanderbilt Health)
5. UB scientists use light to treat a painful side effect of cancer
(University at Buffalo)
6. Cancer Pain - Schmidt
(Stanford CME)
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