Managing Non-Cancer Pain with Opioid Medicines

Opioids are a type of pain medicine (oxycodone, morphine, pethidine, fentanyl and methadone are examples of strong opioids, while tramadol and codeine are relatively weak opioids).

These medicines work well for some types of short-term pain but don’t always get rid of pain completely. They have significant side effects, become less effective over time and can be addictive.

It’s important to only use opioids for the shortest time and at the lowest dose possible.

 

Important questions to ask your health professional:
  • How long will the pain last?
  • How much will this medicine reduce the pain?
  • What to do if the medicine does not help my pain?
  • What are the side effects of the medicine?
  • When should I seek urgent medical attention?
  • When should I next see my doctor?
Pain relief in hospital

Pain is a common experience when you are in hospital. Talk to hospital staff about how pain is affecting you, so that they can help keep you as comfortable as possible.

There are many ways to treat pain. This often includes medicines such as paracetamol, anti-inflammatory medication, and opioids, but other strategies are also important and are mentioned below.

Questions to ask before leaving hospital

Before you leave hospital, make sure you ask your health professional these 5 questions and any other questions you may have.

  1. What is causing the pain?
    The cause of the pain and how long it is expected to last depends on your situation.
  1. What are the possible benefits and potential risks of this medicine?
    Opioids reduce pain – they won’t take the pain away completely. Any benefit needs to be weighed against potential harms, and benefits are not guaranteed in everyone. Opioids can have major side effects, including the possibility of addiction/dependence and overdose (including even death). Other side effects can include drowsiness and constipation.
  1. How long should I take this medicine?
    Opioids should only be used for the shortest time and at the lowest dose possible. Discuss with your doctor or pharmacist when you can lower your dose or stop the medicine altogether. Your doctor or pharmacist can also advise how to safely lower your dose, to reduce problems.
  1. Are there other ways to manage the pain?
    There are lots of effective and safer ways to help manage pain, such as building activity slowly, gentle exercises, mindfulness and relaxation. Most people need to use a combination of strategies.
  1. What is my pain management plan?
    Work with your health professional to develop a plan that works for you. You can use the pain management plan below as a guide.
Will I become addicted?

If opioids are used for short-term pain relief, addiction is not usually a problem, but it is important that you only use them for pain relief.

If you have to take opioids for a long period of time (a week or two) your body will get used to it. This means that instead of stopping the opioid medicine suddenly, you are likely to have to reduce the amount you take slowly to prevent having a withdrawal reaction. This is not the same as being addicted to it.

Top tips to keep you and others around you safe while you are taking opioids:
  • Do not share your medicines with others.
  • Keep the medication securely out of reach of children as even small doses can be extremely harmful. This is also true of pets.
  • Opioids can cause sedation. Do not drive or operate heavy machinery without first discussing with your doctor.
  • Let your doctor know if you are taking other medicines or supplements – sleepiness and other interactions can sometimes occur.
  • Take all leftover medicines to your pharmacy for disposal.
  • Opioids mixed with alcohol are very likely make you feel drowsy – this combination can be harmful and should be avoided.
Make a pain management plan

There are many ways you can manage pain and speed recovery. Work with your health professional to create your personal pain management plan.

Use the following tips to help create your personal plan.

  1. Write down your pain management goal g. getting off pain medication, getting back to work or hobbies, reducing the pain to a certain level, getting on with a normal life.
  1. Physical (body) factors to consider to help with the pain
  • Build physical activity appropriately
  • Physiotherapy
  • Yoga or other gentle exercises
  • Massage
  • Heat or cold pack
  1. Psychological (mind) factors to consider to help with the pain
  • Relaxation
  • Mindfulness
  • Distraction
  • Cognitive behavioural therapy (CBT)
  1. Social (lifestyle) factors to consider to help with the pain
  • Stop smoking
  • Healthy eating
  • Reduce alcohol
  • Better sleep habits
  • Stay socially active
  1. Write down what pain medicines you will trial and use, and how you will take them to gain the most benefit (e.g. paracetamol, anti-inflammatory medicine, opioid, other medicines for pain).
  1. Write down any other notes you may have.

 

Further information on opioids is also available at https://www.healthnavigator.org.nz/medicines/o/opioid-painkillers/.
This resource covers a number of areas including – which opioid is best for you, side effects, how to take opioids safely, advice about driving while taking opioids, using alcohol while taking opioids and how to safely stop opioids. There are also links to other resources, resources in several languages and a video on opioid advice.

Download these tips

Adapted from the NPS MedicineWise advice on “Managing pain and opioid medicines” 2019. Choosing Wisely Australia is an initiative of NPS MedicineWise.

Reasonable care is taken to provide accurate information at the time of creation. This information is not intended as a substitute for medical advice and should not be exclusively relied on to manage or diagnose a medical condition. NPS MedicineWise and Choosing Wisely New Zealand do not assume any responsibility or liability arising from any error or omission or from reliance on any information in this resource.