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Common Misconceptions in the Use of Strong Opioids in Cancer Pain Management

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Many would associate the last stage of cancer to be very painful and filled with suffering. They would think that all cancer patients may have to go through this stage and the only way they can manage the pain is through taking morphine or other strong opioids that are deemed undesirable, owing to the common association of such drugs and its liability to cause addiction and other side effects. Find the answers to your questions on morphine and opioid usage here.

Misconception #1

All cancer patients suffer from severe cancer pain.

Not all patients with advanced cancers suffer from cancer pain. Some studies have suggested that about ¼ of patients do not suffer from any pain. ¼ have mild pain, ¼ have moderate pain, and only ¼ have severe cancer pain.

Misconception #2

All cancer pains are managed by morphine or other strong opioids.

Morphine and other strong opioids are useful for severe cancer pain. For mild or moderate cancer pain, other medications such as paracetamol, non-steroidal anti-inflammatory drugs (such as diclofenac, naproxen , celecoxib) and weak opioids (such as codeine, tramadol) are used. If pain is caused by the nerve being damaged or affected, it is known as neuropathic pain. Under such circumstances, patients will require drugs such as Lyrica® or gabapentin to achieve effective pain relief.

Misconception #3

Morphine or other strong opioids have many intolerable side effects.

For patients who require morphine or other strong opioids for cancer pain, the common side effects that may be experienced are drowsiness, constipation, nausea and vomiting. These side effects can be easily managed.

  • Drowsiness

The patient may feel drowsy when he starts to take morphine or other strong opioids, or when the dose is increased. The drowsiness usually only last for a few days. However if the symptom persists, or is severe, patients may discuss with their doctor to see if there is a need to reduce the medicine dosage.

  • Nausea and Vomiting

Out of three patients who take morphine or other strong opioids to relieve pain, only one will experience nausea and vomiting. These symptoms can be prevented through taking anti-vomiting medicine such as metoclopramide or domperidone. After taking morphine or other strong opioids for some time, many patients may get accustomed to the medication and no longer experience any nausea and vomiting.

  • Constipation

Constipation is a more common side effect. However, it can often be easily managed by consuming adequate fluid and taking common laxatives such as sennokot or lactulose. Targin®, which is a combination drug containing oxycodone (an opioid) and naloxone, can be used in patients with severe opioid-induced constipation to reduce the side effect.

Misconception #4

Regular intake of morphine or other strong opioids for cancer pain may lead to addiction.

The act of taking morphine or other strong opioids regularly to control the cancer pain is not an addiction. Patients who are taking morphine or strong opioids for cancer pain under the advice of an experienced doctor do not become addicted.
When the pain can be relieved by other means, such as radiotherapy for cancer bone pain, the dose of morphine or strong opioids can be reduced significantly or even stopped.

Misconception #5

Morphine should only be used as a last resort especially when death is near.

The use of morphine or other strong opioids should be on the basis of the need for pain management and not determined by patients’ proximity to death. Many patients who are far from end of life have benefitted from significant pain relief brought by strong opioids. When pain is relieved, the patient's quality of life improves.

Misconception #6

The use of morphine or strong opioids lead to death for some patients.

The use of morphine or other strong opioids does not lead to death, especially if it is started at a low dose and is increased gradually. However, when the strong opioid is started or increased when the patient is very ill and is dying from a life-threatening disease, blame might be mistakenly placed on the strong opioid used when the patient subsequently passes on. The patient will die from his existing life-threatening illness, independent of the administration of morphine or other strong opioids. Morphine or other strong opioids used here is likely to relieve pain and breathlessness during the dying phase.

Misconception #7

All patients who are dying should be given morphine or other strong opioid to ensure that they will not suffer from any pain.

Some patients who are dying do not suffer from pain or are in distress. Therefore, morphine or other strong opioids are not required. Taking them when not required may result in unnecessary side effects.