Opioid Painkillers and Cancer Care

Cancer patients require a wide variety of options for their care, both curative and palliative. Sometimes that includes heavy-duty pain medications. There are times when those drugs fall under the classifications for controlled substances, making them harder to obtain, and the patients themselves become subject to scrutiny.

Different types of pain

If pain is associated with inflammation, for example, a non-steroidal anti-inflammatory drug like ibuprofen might be recommended, or even a shot of cortisone for more direct or intense relief. Such treatment might even cure the problem that caused the pain. There are times when acetaminophen or other analgesics might be more than enough to do the trick. Most of these drugs, and especially over the counter versions, are effective at treating the types of sensations that are transmitted via the nervous system from the source to the brain. This is appropriate when there is an injury to tissue, muscle spasms, or an inflammatory response that causes the pain. Such treatments may be more than enough to deal with headaches, body aches, and joint pain.

There are times, however, when the pain begins and ends with the nervous system itself. Neuropathic pain, caused by damage to an actual nerve, is sometimes difficult to treat and even harder to live with. Treatment may require drugs designed for other nerve-related conditions, such as epilepsy or depression, which either alone or in combination with other drugs affect the way the pathways of the nervous system function. While anti-convulsants and anti-depressants may be very effective at controlling some types of neuropathic pain, they have the drawback of potentially taking a long time, sometimes as much as two or more weeks, before becoming effective.

Non-drug options

For quick, temporary relief of nerve-related pain, electrical stimulation may be effective. The use of a portable TENS unit, which consists of a controller and at least two small pads that fix electrodes to the patient's skin, can disrupt the pain signals going along the damaged nerve between the location of the pain and the brain. While such stimulation can offer relief, it tends to be temporary and it simply does not work on all types of nerve-related pain or for all patients.

Other non-drug approaches include heat and cold packs or topical gels and creams. Such treatments may offer temporary relief, but again are unlikely to create lasting effects unless the nerve pain is caused by another source that can be treated in this manner (such as a swollen muscle).

The opioid stigma

For many patients, the only solution left is to take a more powerful painkiller.

Opioids are a class of drugs that bind to receptors in the body's neurological network, dulling pain that other types of drugs may not affect. Because opioids are classified as narcotics, they are heavily regulated. This has become a greater issue recently due to the over-prescription of these drugs, which has led to a high number of deaths associated with abuse of the medication. As a result, there has been a backlash against opioids and, by association, the patients who rely on them for legitimate pain relief. In cancer patients, where pain may not be treatable through other means, opioids are often the only option that works.

But obtaining opioids can be difficult. Sometimes there is reticence from a doctor, in which case it may take some serious discussion from the patient to assure the doctor that this is necessary. Unfortunately, insurance companies and many medical offices put up resistance to opioids because of the potential for abuse. Many pharmacies do not even keep opioids in stock, requiring special orders that could take several days to fill. However, when used appropriately, opioids are able to dramatically improve the quality of life for patients suffering from chronic pain that has no other effective means of control.

Be your own self-care advocate

Advocating for self-care may be difficult for some patients, but it is an essential skill to acquire. Cancer pain, unique to each patient, manifests in many ways and may be particularly hard to convey in terms that others understand, even those with medical backgrounds. While not appropriate for every patient or every condition, opioids are a means of offering relief to many patients who otherwise would continue to suffer unduly. When necessary, they should be considered as an option, one more tool in the cancer patient's ever-expanding toolbox.^1-3

Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.