Pain Thoughts: Identifying and replacing thoughts that are not helpful
Thinking about how much pain you are in does not help you cope with the pain; As pain increases, thoughts may become more negative; as thoughts become more negative, pain often increases further.
Negative thoughts can lead to:
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Worsening mood
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Avoiding activities
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Isolating/avoiding others
Although pain thoughts can be automatic, with practice you can become more aware when you have them. Then you can replace unhelpful thoughts with ones that are helpful.
Here are some examples of unhelpful pain thoughts and some coping statements that you can use to replace them:
Make a list of your priorities each day, and focus on 1 or 2 each day
Spread out activities and make sure to rest in between – 5-10 minute breaks can go a long way
Schedule the most important things for the time of day you feel the best
Be kind to yourself and don’t worry if you don’t get through your list
Want to learn more about how to pace your activies? Watch this short video.
Many people have a hard time accepting help. Letting people help you can be a gift to them. They want to show how much they care. Here are some tips:
Give people specific ideas and tasks they can help with, like laundry, yard work, cooking, cleaning, or errands
If pain keeps you up at night, try taking your short-acting opioid at bedtime.
Limit daytime sleeping to 1 or 2 short (15-30 minute) naps per day
Avoid caffeine and alcohol
Try not to watch TV or use screens for at least 30 minutes before bedtime
Make your bed only for sleeping. If you need to relax during the day, find another place.
Have a regular sleep schedule. Go to bed and wake up at the same time each day.
Want to learn more about how sleep and pain are connected? Read more here.
Physical activity (staying active) is one of the best ways to boost your energy. Some people can do more than others, but wherever you are is okay. Ask your care team for a safe physical activity plan. Here are some general tips:
Exercise does not have to be difficult. Find something you enjoy that gets your body moving. Good examples are walking, cooking, playing with children or pets.
Try walking 5-10 minutes, a few times per day. Slowly build up as able. Any walking counts, even if it’s around your house.
Do something fun while you walk, like listening to music, or talking to a friend.
If activity causes you pain, don’t forget to take your short-acting opioid 30 minutes beforehand.
Worrying can make your fatigue worse. If you’re struggling with worrying, read more about the connection between stress and pain, and see what has worked for other people.
Laxatives are medicines that help with constipation (such as Senna ® or Miralax ®). Start taking laxatives as soon as you are on opioids. Don’t wait until you are constipated.
Make it a goal to have a good bowel movement every day or two. If you haven’t gone in more than 24 hours, increase the dose of your laxatives, or add another laxative. Tap to learn more about adjusting your laxatives. Also – if you report your constipation in this app, we will offer advice on what to do with your laxatives.
Sometimes laxatives can work too well, and you may have loose stools or diarrhea. If this happens, stop the laxatives until your diarrhea has been gone for about a day.
When your diarrhea has been gone for about a day then restart your laxatives at a slightly lower dose (Tap for specific advice about how to adjust laxatives).
Don’t make the mistake of stopping your laxatives completely: this can cause the “yo-yo” problem where you become very constipated again, you need high doses of laxatives, then the yo-yo swings in the opposite direction towards diarrhea.
Without laxatives, it’s hard to get your stool moving. Here are some other things you can do in addition to laxatives that may help:
Drink a lot of fluids. Aim for 8 cups per day. Any fluids (except alcohol) count! It can be water, soup, juice, milk, tea, or any drinks you like.
Pay attention to other medications. Some medicines can make constipation worse. These include common anti-nausea medicines like ondansetron (Zofran), palonosetron (Aloxi), and granisetron (Kytril). If you find that these medicines make your constipation worse, try increasing your laxatives on the days you need to take them. You can also talk to your care team about other anti-nausea medicines that don’t cause constipation.
Be active! Even walking slowly for 5-10 minutes at a time can help move things through.
Eat more fiber in your food. Try raw fruits and vegetables, oatmeal, or other whole grains. Some fiber-rich foods (like broccoli or cabbage) may cause gas and bloating, so listen to your body and notice what helps and what doesn’t. Tap to learn more about nutrition and constipation.
Foods to avoid: Try not to eat too many foods that cause gas, like cabbage, broccoli or fizzy drinks. Also, try to limit the amount of foods you eat that cause constipation like meats, cheese, chips, fast food, or processed foods like hot dogs or some microwave dinners.
Avoid fiber supplements: This sounds confusing, but most fiber supplements (like Metamucil or Citrucel) can make the stool bigger and harder to pass. So - experts say when taking opioids, STAY AWAY from fiber supplements all together.
Cancer doctors and nurses take constipation seriously. Here are some reasons to call your care team:
If you haven’t had a stool in 4 days or more
If you haven’t passed gas from your bottom in more than a day
If you have constipation and symptoms like sharp belly pain or vomiting
“My cancer must be growing if it hurts this much.”
“This pain won’t ever get better.”
“This pain will be the end of me.”
“Nothing will work.”
“Nothing makes the pain better.”
“I always have pain when I try to do ________.”
“I can’t do any of the things I want to because of my pain.”
“There are things I can do to manage this pain.”
“This pain doesn’t define who I am.”
“I’m working with my doctors to learn better ways I can manage my pain at home.”
“My pain isn’t always bad. There are times it feels better.”
“I’m getting the help I need to learn about ways to make my pain better.”
“I’m not alone in this. I have people to support me, and a care team to help me manage my pain.”
Missing social events because of pain
Missing work or working too much
Wanting to isolate when pain is worse
Spending time with people you care about
Attending social or cultural events that are meaningful to you
Attending Church, Synagogue, Mosque or other religious services
Going to community events like sporting events
Getting help from loved ones
Sharing your feelings about pain with a trusted friend, and knowing you’re not alone in managing your pain
Try to pick something you used to do enjoy doing but find an easier way to do it. Watching sports with friends instead of playing them. Walking around the park instead of running. Get creative. Talk to trusted friends to help come up with something that makes sense for you.
Time can be a helpful tool to stay within your limits and to not overdue it. Use time limits to set realistic goals You can slowly increase the time to improve your endurance when you feel ready. If it doesn’t start to feel easier, reduce the time or intensity, or pick something easier. Read more about pacing your activities here.
Try the activity once a week for a while, increase it after a few weeks when you feel comfortable.
If for a while you enjoyed an activity, keep that going. If you start to notice that the goal is less meaningful to you, pick something else.
Start by choosing an activity that is meaningful to you. It should be something important to you, something you enjoy, and something realistic. People often choose something that fits into their everyday life like light housework or home repairs, cooking, gardening, or walking. Or they chose an activity that has a social aspect to it – like going out to dinner with friends, shopping, or going to a sporting event.
Whatever the activity, start with baby steps. If your goal involves walking, start with a distance or amount of time you know that you can do comfortably. People try to start with what they used to before they were sick. This usually isn’t a good idea. Try to start with something more realistic. Overdoing it at the beginning can make your pain flare up, discourage you, and get you stuck back in the pain cycle.
Once the activity feels comfortable, stick to that same routine for a few days. This helps build your endurance. Then - increase the time you spend doing that activity by a few minutes. Or make the activity a little bit more difficult (like walking faster).
Check in with yourself often and notice how your energy and pain are doing. You will start to learn your body’s signals that you’re pushing too hard, or that you’re ready to step up your activity level.
Even if you’re feeling ok, it is important to stop and rest after physical activity. This helps your body recover and prevents your pain from worsening.
If you know that an activity always causes pain, it can help to take your short-acting opioid (your “breakthrough” pain medicine) about 30 minutes ahead of time. Over-the-counter pain medicines like ibuprofen (Advil) or acetaminophen (Tylenol) can also help, if your care team has said that these are safe for you. Using pain medicines wisely is an important part of building strength and endurance.
Get affirmation from your care team about your concerns. Remember pain can trick us into thinking we should avoid movement, yet sometimes this isn’t always true. At times, pain gets better with more movement.
There will be days you don’t feel up to what you did yesterday. Try to do the activity even still. Maybe do it for a shorter time, or break up your normal activity time with rest breaks. Try not to avoid activity all together. It can be easy to lose the gains you’ve been working so hard for.
Sometimes little tasks can take up a lot of energy. Try to ask others for help and save your energy for tasks and activities that are really important to you.
Alternating tasks throughout the day can help you to sustain your energy throughout the day. This way, you don’t lose all your energy at once, and can rest during or between easier activities.
Opioids reduce hormones like testosterone. This affects different aspects of your sexual functioning. Changes can include:
Lack of desire for sex
Difficulty having or maintaining an erection (erectile dysfunction, or “ED”)
Reduced pleasure during sex
Problems with ejaculation
Pain or numbness during sex or in genitals
Negative feelings about sex or your body
Though the direct pathways are unclear, opioids can change nerve signals and hormones that affect sexual functioning. Changes can include:
Lack of desire for sex
Reduced pleasure during sex
Problems with orgasm
Pain or numbness during sex or in genitals
Vaginal dryness or tightness
Negative feelings about your body
Medicines like Senna (aka Senakot or Ex-lax), bisacodyl (Dulcolax) work by making the muscles in your gut squeeze more often to move stool through faster. At the drug store, these are often called stimulant laxatives.
Medicines like polyethylene glycol (Miralax) Milk of Magnesia, Lactulose, or Magnesium Citrate work by bringing extra water into your gut. They make stool looser and easier to pass. Make sure you drink enough water with these.
Stool softeners like docusate (Colace) are weak and are rarely enough on their own. If you are sensitive to laxatives or get loose stools easily, stool softeners may be a good choice.
If stool sits in your body for too long, it can get very hard to pass. This is when enemas or suppositories can be helpful. Suppositories like glycerin or Dulcolax draw water into your rectum and loosen hard stool so you can pass it. Enemas (like Fleet’s saline, mineral oil, or phospha-soda enemas) also add fluid to flush out the stool. Enemas can be uncomfortable, but they help if you are in a bind. Before trying this option, ask your care team if enemas or suppositories are safe for you.
Many over-the-counter laxatives can be increased or decreased depending on how severe your constipation is. Senna (Senakot) and polyethylene glycol (Miralax) are most commonly used this way. My Daily Constipation Plan gives instructions on how to adjust these two laxatives to manage your constipation on a daily basis.
Also – if you fill out your daily survey, we will give you suggestions about how to adjust your laxatives. If your doctor has given you specific instructions for adjusting your laxatives, use that plan. Talk to them if the plan isn’t working.
If the medicines in the daily constipation plan or the constipation rescue plan don’t work for you (or don’t agree with you), talk to your care team. They might recommend some types of medicines. We have listed some of them below. Talk to your care team before using them.
If your laxatives are causing diarrhea, stop taking your laxatives. Once your diarrhea has stopped and been gone for a day, restart your laxatives at a lower dose. There isn’t a right or wrong way to decrease your laxatives, but a common approach is to cut the doses in half. Your care team can give you more advice if you need it, or you can read more about adjusting laxatives here.
Senna usually comes in 8.6mg tablets, which are taken once or twice per day. Senna works by making the muscles in your gut squeeze more often and by drawing extra water into the stool. Tap to learn more about Senna.
Miralax is a powder sold in boxes of single-dose packets, or in larger bottles. Miralax is taken by mixing the powder into liquid and drinking once or twice per day. It works by drawing extra water into your stool. Tap to learn more about Miralax.
Docusate (also called Colace) comes in capsules, and works by softening the stool. Tap to learn more about docusate.
Bisacodyl comes in 5 mg tablets, which are taken once or twice per day. Bisacodyl works by making the muscles in your gut squeeze more often and by drawing extra water into the stool. Tap to learn more about bisacodyl tablets.
This medicine is a chalky liquid that comes in a bottle that is taken with water. You can also find it in chewable tablets. It works by bringing extra water into your gut. Tap to learn more about Milk of Magnesia.
This is a medicine that you put in your bottom. It draws water into your rectum to help loosen and pass stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about glycerin suppositories.
This is a medicine that you put in your bottom. It draws water into your rectum to help loosen and pass stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about bisacodyl suppositories.
This medicine comes in an over-the-counter kit that is used to add fluid to your bottom, to flush out stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about sodium phosphate enemas.
This medicine comes in an over-the-counter kit that is used to add fluid to your bottom, to flush out stool. ALWAYS ask your care team if suppositories are safe for you before using them. Tap to learn more about tap water enemas.
Go to bed and wake up at the same time, every day. This helps your body’s clock stay regular, which can also help with pain.
Creating calming “bedtime rituals” can help teach the body that it’s time to relax and go to sleep. Some people do relaxing stretches, shower or take a warm bath before bed, do breathing or relaxation exercises (try one here), or enjoy a hot cup of sleepy time tea (caffeine free).
Your bed should only be used for sleeping and for sex. Activities like reading or watching TV should be done somewhere else. Why? This makes it easier for your brain to connect your bed with sleep, which makes it easier to fall asleep and stay asleep.
If you’re stressed about falling asleep, watching the clock can make this even worse. Try hiding your clock before bed or facing it another direction. Why? This makes it easier for your brain to connect your bed with sleep, which makes it easier to fall asleep and stay asleep.
If you’re lying in bed for more than 20 minutes and cannot sleep, get up and do a quiet activity. This could be reading a book, folding laundry, or washing dishes. Avoid bright lights and avoid using electronic screens (including your cell phone) because these tend to wake you up more. After 15 minutes, try going back to bed. Lying awake in bed makes your brain associate your bed with staying awake- so try getting up for a bit and coming back to bed later. This can help cue you to fall asleep again.
Avoid caffeine, nicotine and alcohol for at least 6 hours before bedtime. Caffeine (in coffee, tea, soda, and chocolate) or nicotine (in cigarettes or e-cigarettes) “activates” your brain and makes it harder to fall asleep. Although many people find alcohol relaxing, it actually interrupts sleep and worsens your sleep quality.
It’s important to get good rest when you are dealing with cancer but taking naps can make it harder to sleep at night. Over time, this can make your body lose its natural cycle of rhythm and rest. If you need to take a nap, try to keep it to no more than 30 minutes.
Regular exercise can be particularly helpful to improve the quality of your sleep. However, timing is everything! It’s best to avoid strenuous exercise about 4 hours before bedtime. Instead, try doing an activity in the morning that is both enjoyable and gets your blood pumping.
Diphenhydramine (Benadryl)
Doxylamine (NyQuil)
Chlorphenamine (ChlorTimetron)
Brompheniramine (Bromfed, Dimetapp)
Hydroxyzine (Vistaril, Atarax)
Meclizine (Antivert)
Alprazolam (Xanax)
Clonazepam (Klonopin)
Diazepam (Valium)
Lorazepam (Ativan)
Temazepam (Restoril)
Haloperidol (Haldol)
Olanzapine (Zyprexa)
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Amitriptyline (Elavil, Vanatrip)
Nortriptyline (Pamelor)
Doxepin (Silenor, Sinequan)
Mirtazapine (Remeron)
Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol XL)
Propranolol (Inderal)
Tape the edges down with paper first aid tape or use an adhesive film dressing (such as Bioclusive or Tegaderm). If your patch falls off, throw it away and apply a new patch in a different area. If this happens, notify your care team. Otherwise, you may run out of medication early.
Keep the patch on during showers. Do not let hot water run over the patch. This can make the medicine absorb into your body too quickly, which is dangerous. If you notice the patch coming loose during showers, try using first aid tape or a dressing to keep it in place.
Change your patch as soon as you remember it. If you are more than about 12 hours late, you may notice your pain being poorly controlled for about 12-24 hours while medicine from the new patch works its way into your system.
Always follow the prescription instructions, and call your care team if you have any questions.
Acetaminophen is safe when taken as directed; however, if a person takes over the recommended limit they can be at risk for serious liver damage. People at the highest risk for liver damage are those who already have problems with their liver. Having tumors in the liver does not always increase the risk of side effects; however, always talk to your doctor for specific advice.
If you’re using regular strength (325 mg tablets), do not take more than 9 tablets in 24 hours.
If you’re using extra strength (500 mg tablets), do not take more than 6 tablets in 24 hours.
Other medicines sometimes contain acetaminophen in them. Be especially careful when taking these other medications not to exceed the daily maximum.
Always ask your care team first before taking ibuprofen. Ibuprofen may not be safe for you if you have kidney problems, bleeding problems, or if you are on blood thinners.
Make sure you drink plenty of fluids (at least 2 liters per day) while taking ibuprofen. This helps protect your kidneys from the effects of ibuprofen. If you have severe vomiting, diarrhea, or difficulty keeping down fluids – call your care team and stop taking ibuprofen.
Always follow your doctor's instructions when taking ibuprofen, and call your care team if you have any questions.
If your doctor told you to use less than this, always follow that instruction. Taking too much ibuprofen can cause damage to the kidneys and can cause bleeding. Other medicines sometimes contain ibuprofen in them. Be especially careful when taking these other medications not to exceed the daily maximum.
Always ask your care team first before taking naproxen. Naproxen may not be safe for you if you have kidney problems, bleeding problems, or if you are on blood thinners.
Make sure you drink plenty of fluids (at least 2 liters per day) while taking naproxen. This helps protect your kidneys from the effects of naproxen. If you have severe vomiting, diarrhea, or difficulty keeping down fluids – call your care team and stop taking naproxen.
Always follow your doctor's instructions when taking naproxen, and call your care team if you have any questions.
Never take more than 3 tablets (660 mg total) in 24 hours, unless your doctor has specifically told you to. Taking too much naproxen can cause damage to the kidneys and can cause bleeding.
Always follow the prescription instructions and call your care team if you have any questions.
Because gabapentin can sometimes cause sleepiness and dizziness, do not drive until you know how you feel on this medicine. Remember, most states do not allow people to drive if they are taking opioid pain medications.
Drinking alcohol while taking gabapentin can increase side effects like dizziness and sleepiness.
To stop gabapentin, your doctor will need to slowly taper the dose. Stopping gabapentin suddenly can put you at risk for a seizure.
Always follow the prescription instructions and call your care team if you have any questions.
Because pregabalin can sometimes cause sleepiness and dizziness, do not drive until you know how you feel on this medicine. Remember, most states do not allow people to drive if they are taking opioid pain medications.
Drinking alcohol while taking pregabalin can increase side effects like dizziness and sleepiness.
To stop pregabalin, your doctor will need to slowly taper the dose. Stopping gabapentin suddenly can put you at risk for a seizure.
Always follow the prescription instructions and call your care team if you have any questions
To stop this medicine, your doctor will need to slowly taper the dose. Stopping duloxetine suddenly can put you at risk for negative side effects.
Always follow the prescription instructions and call your care team if you have any questions.
To stop this medicine, your doctor will need to slowly taper the dose. Stopping nortriptyline suddenly can put you at risk for negative side effects.
Always follow the prescription instructions and call your care team if you have any questions.
To stop this medicine, your doctor will need to slowly taper the dose. Stopping amitriptyline suddenly can put you at risk for negative side effects.
Always follow the prescription instructions and call your care team if you have any questions.
Because baclofen can sometimes cause sleepiness and dizziness, do not drive until you know how you feel on this medicine. Remember, most states do not allow people to drive if they are taking opioid pain medications.
Drinking alcohol while taking baclofen can increase side effects like dizziness and sleepiness.
To stop this medicine, your doctor will need to slowly taper the dose. Stopping baclofen suddenly can put you at risk for negative side effects.
Always follow the prescription instructions and call your care team if you have any questions.
Because carisoprodol can sometimes cause sleepiness and dizziness, do not drive until you know how you feel on this medicine. Remember, most states do not allow people to drive if they are taking opioid pain medications.
Drinking alcohol while taking carisoprodol can increase side effects like dizziness and sleepiness.
To stop this medicine, your doctor will need to slowly taper the dose. Stopping carisoprodol suddenly can put you at risk for problems include vomiting, abdominal pain, headache, and hallucinations.
Always follow the prescription instructions and call your care team if you have any questions.
Because tizanidine can sometimes cause sleepiness and dizziness, do not drive until you know how you feel on this medicine. Remember, most states do not allow people to drive if they are taking opioid pain medications.
Drinking alcohol while taking tizanidine can increase side effects like dizziness and sleepiness.
To stop this medicine, your doctor will need to slowly taper the dose. Stopping tizanidine suddenly can put you at risk for dangerous side effects including a fast heart rate and high blood pressure.
(MS-Contin, Morphine ER, Oxycontin): These medicines start get into your system very soon after taking them. They usually wear off in about 12 hours.
Fentanyl patches take time to absorb through your skin, so it can take up to a day for it to get fully into your system. For this reason, if you are just starting this medication (or increasing the dose), you won’t feel the full effect for about a day. The patch usually starts to wear off after 3 days, which is why most prescriptions say to change the patch every 72 hours. If you take your patch off sooner than this, it will wear off in about a day.
Methadone isn’t a “slow release” version of an opioid, but it stays in the body for a long time. For this reason, it is used like other “long-acting” opioids to get predictable, long-lasting pain control. Most people will notice pain relief about an hour after taking methadone. It will take 3 days before you feel the full effect of methadone, when the medicine reaches what’s called a “steady state.” Until you get the full pain relief from methadone, you may need to use your short-acting opioid more often to control your pain.
This can make you absorb the medication too quickly, which is dangerous.
Here are tips to help:
Connect taking your medicines to activities you do at the same time every day like brushing teeth, a meal, or going to bed
Set a timer on your clock or smartphone
If you use a medication planner (like a weekly pill box), double check your medicines so that you don’t make mistakes. Never move your medicines from your pill box back into the prescription bottle (they can be easily mixed up). Keep your pill box away from children or pets.
Your short-acting medicine is meant to handle spikes in your pain. Remember, your long-acting opioids are helping in the background too, to keep your pain under better control.
YES. Use your short-acting opioid for a pain spike. If it’s also time for your scheduled long-acting medicine, by all means, take them at the same time. It is not dangerous to take them together, this is how they are meant to be used.
YES. Remember they are working in the background to help keep your overall pain level lower. NEVER stop taking your long-acting opioid suddenly. This can cause symptoms of withdrawal, including pain, nausea, diarrhea, sweating, and anxiety. Always talk to your care team first if you think that your opioid prescriptions need to be changed.
A good rule of thumb is if you are no more than 2-3 hours late taking your long-acting opioid, go ahead and take it as soon as you realize that you have missed the dose. If you are later than this, talk to your care team about what to do. They might have you take your missed dose, and they may also instruct you to retime your next scheduled dose.
When taking opioids, stay away from drinking alcohol. This can make the sedating effects of opioids worse. Over the course of your treatment, you may also be prescribed other medications that can sometimes cause drowsiness. Try to take these medications at a different time than your short-acting opioids. Tap to see a full list of other medicines that can make you drowsy.
If you are on a very high dose of opioid pain medications or have other risk factors for opioid overdose (see above), talk to your doctor about having Narcan (Naloxone) at home. In the rare case of an opioid overdose, Narcan (Naloxone) reverses the effects of the opioid and could save your life. Make sure that the people who spend the most time with you know how to give Narcan (Naloxone), and when to give it. In many states you can get Naloxone from the pharmacy without a prescription. The pharmacist can teach you how to use it.
Many states have laws saying you cannot drive while taking opioids. The reason is that opioids can slow your thinking and your ability to react to changes on the road. We understand this can be incredibly difficult, isolating, and life-changing. Although hard, there are ways to adapt. It is most important to tell your friends and family that you need help with transportation and be okay accepting their help. Here are some other resources you can use.
Public Transportation: Many cities, including Boston, have public transportation systems with trains and buses. These systems usually have extra services for people with health problems like cancer. Here are examples of extra support within Boston’s public transit system, the MBTA.
The RIDE is a door-to-door, shared-ride service. Apply here.
Boston Age Strong Shuttle provides shuttles to non-emergency medical appointments for qualifying persons (call 617-635-3000)
Bus Buddies: A trained volunteer Bus Buddies is available to help you navigate the MBTA, public transportation in Boston. Call 617-635-4366 for more information
Taxi Coupons: The city of Boston sells taxi coupons at a 50 percent discount to Boston residents age 65 and older at the office in Boston City Hall. You can call Boston City Hall at (617) 635-4500.
Ride Sharing Apps: There are several ride sharing apps including Lyft and Uber that can help you maintain independence. Most platforms have a ride sharing option, which is usually less expensive.
It’s important to keep track of your medicine, including how many you take each day and how many pills you have left. It can be easy to lose track and accidentally take too much in a day. This can help you know when to ask for a refill too. If you’re running out, call you care team and request a refill for a medicine, as this can take up to 5 days.
Use this app to keep track of how you feel when taking opioids. If you have a side effect that worries you, call your care team as soon as possible. Tap to learn more about opioid side effects.
Only tell the people directly involved with your care that you are using opioids to manage your pain.
Don’t leave opioid medication bottles out on the table, kitchen and bathroom counters, or on your bedside table. Keep them in a place where they are safe, and they cannot be accidentally (or purposely) taken by someone else. Ideas include a medicine cabinet or bedside drawer.
If you have small children in your house, or if anyone with an addiction problem has access to your home, the safest place to keep your medication is a lock box.
If you stopped taking one of your pain medications, try not to keep the pills around your house. Drop off them at your local pharmacy or your local police station, to be destroyed.
This is a rule your doctor follows to keep you safe. Doctors prescribe a low dose of opioids to start. If needed, they slowly increase the dose until you find what works best for you. In the same way, the first time you take an opioid (or if your prescription is changed), you should always try the lowest dose first. For example: if your prescription says: “take 1 or 2 tablets as needed for pain,” start with one tablet. If you tolerate it, the next time you need pain medicine it is okay to try the higher dose.
If possible, it is best to have company the first time you take a new opioid medication, just in case you have a side effect you didn’t expect. Also, it’s best to take the opioid medication at least a few hours apart from any other medication that might cause drowsiness.
Over time, our bodies can get used to opioids, and we may need more medicine to get relief. This is called tolerance. If this happens, don’t increase your medication on your own. Work with your care team to find the dose that works for you and stick to that dose.
Also, if you find that your pain gets a lot better, don’t stop taking your opioids without talking to your care team. Stopping your opioids suddenly can cause you to go into withdrawal. Symptoms of withdrawal include diarrhea, vomiting, pain, and flu-like symptoms. Talk to your care team to create a safe plan if you are interested in lowering your opioid dose or trying to get off of it.
The bottle labels can be confusing. Make sure to ask your doctor, nurse, or pharmacist if you have questions about the instructions.
Although weekly pill organizers can be very helpful for some medications, you should keep your opioids in their original bottle. It is easy to get pills mixed up with each other and accidentally take the wrong amount.
This makes your body absorb the medicine more quickly, which can be dangerous. Talk to your care team if you are having trouble swallowing your pills.
A good rule of thumb is if you are no more than 2-3 hours late taking your long-acting opioid, go ahead and take it as soon as you realize that you have missed the dose. If you are later than this, talk to your care team about what to do. They might have you take your missed dose, and they may also instruct you to reschedule your next scheduled dose.
Opioids draw water out of your stool and slow down the muscles in your gut. This makes your stools hard and difficult to pass. Sometimes it’s not easy to know if you are constipated. If your stools are hard, if you are going less often, or if you are straining to go – you are constipated.
Unless your doctor tells you otherwise, when you are on opioid medicines you should be taking medicines to prevent constipation, which are called laxatives. Tap to learn more about constipation.
Sleepiness or drowsiness are common symptoms of cancer and cancer treatment. Opioids (especially short-acting opioids, also known as “breakthrough” pain medications) can also cause drowsiness. Drowsiness is usually worse for a few days after starting an opioid or increasing the dose. It often clears up on its own, so be patient. If your drowsiness does not clear up within 3 days of starting a new dose, here are some changes you might try. Little changes can make a big difference.
Avoid taking your opioids at the same time as other medicines that cause sleepiness. Here are a few common medicines that can make you feel drowsy:
Nausea medicines: Compazine (prochlorperazine), Phenergan (promethazine), Ativan (lorazepam)
Anxiety medicines: Ativan (lorazepam), Xanax (alprazolam), Klonopin (Clonazepam)
Allergy medicines: Benadryl, Zyrtec, Claritin
Other pain medicines: Neurontin (gabapentin), Lyrica (pregabalin)
If your short-acting opioid is prescribed with a range of doses, start with the lowest dose first and work your way up.
Try using fewer opioids at times that you need to be most alert.
If you can have caffeine, try a beverage like coffee or green tea.
Ask your doctor about medicines that might help you be more awake during the day.
Cancer and cancer treatment commonly cause fatigue. Opioids can make fatigue worse. Fatigue is an overwhelming sense of tiredness, lack of energy, or feelings of exhaustion. If you notice that you’re getting sleepy or nodding off after taking your opioids, this sounds more like drowsiness.
Read more here about some good ways to manage your fatigue and improve your energy.
You may feel nauseous when you’re taking opioids, but it should go away after a few doses. If it doesn’t, here are a few things that might help:
Try taking an anti-nausea pill (like Compazine or Zofran) about 30 minutes before taking your opioid
Try drinking ginger tea
Some people find that eating a small snack before taking your opioid may help
Try resting for about an hour after taking your pain medicine, so your stomach can settle
If your nausea continues, talk to your care team
Some people taking opioids describe feeling foggy, or not as sharp as usual. This can improve with time.
For some people, feeling foggy can be just as bothersome as having severe pain. For others, it’s more important to have their pain under control. Only you can decide the right balance for you.
If fogginess doesn’t go way, try using your opioids at times of day when you don’t need to be as sharp (like while watching TV).
Talk to your care team about these symptoms. Sometimes other medications can help balance out feeling foggy.
Rarely, people feel dizzy or light headed after taking an opioid. If you’re experiencing this, you should discuss your symptoms with your care team.
Dizziness sometimes happens when someone stands up after sitting or lying down for a while, especially if a person’s blood pressure runs low. Here are some things you can try:
Make sure to drink plenty of water (at least 8 cups per day). Dizziness may happen if you’re dehydrated.
Change positions slowly to give your body time to adjust
Sit on the edge of the bed for a few minutes before standing up.
If you are still feeling dizzy after a few minutes, don’t stand up.
Hold onto something when you stand up., sit back down if you feel dizzy when you stand up so that you don’t fall.
Call your care team if you have new or worsening dizziness.
Being in pain and taking opioids can cause changes to your sexual health. It can be easy to overlook the importance of sexual intimacy. But feeling intimacy and connection can be an important part of coping with pain and cancer in general.
Read more here about changes in sexual health.
Opioids can affect how you feel, and this can be different for everyone.
Some people describe feeling sad or irritable with opioids. Other say they feel moody or more emotional.
On the other hand, when opioids help to reduce your pain, your mood is likely to improve. Being in pain is depressing. Being depressed makes pain worse. It’s a vicious cycle. This is why having a pain medicine plan can be a really important way to improve your mood.
If mood changes are greatly interfering with your daily life, talk to your care team. You can also read more here about how emotions and pain are connected.
It is not rare or harmful for some people who use opioid medications to feel unusually happy or good when they take them. This is because of how the medication affects the emotional part of the brain.
If you are taking your opioid medication the way it was prescribed, these feelings may go away when your body gets used to the medicine.
If this feeling makes you worried, talk to your care team.
Some people notice their mouth feels dry when taking opioids. This is because opioids can slow down how much saliva (spit) your mouth makes. Dry mouth can also be caused by other medications, especially chemotherapy.
Here are some things you can try:
Sip on water or suck on ice chips
Try things that create more saliva (spit) in your mouth
Suck on slices of lemon, lime, or other citrus fruits (avoid if you have mouth sores from chemo or any other reason)
Suck on sour candies
Chew sugar free gum
Try using alcohol-free mouth wash, or salt-water rinses a few times per day
Try using Biotene® mouthwash, lozenges, or toothpaste. These are moisturizing for your mouth and can feel soothing
Avoid alcohol-containing mouthwashes
If your mouth is uncomfortably dry, call your care team or dentist and ask about more things you can do to help.
Some people may notice difficultly starting the flow of urine (pee) or having a weak flow. This is not a common opioid side effect. If you already had troubles urinating before taking opioids (for example - if you have an enlarged prostate), opioids can make this worse.
Difficulty urinating is not usually serious, but occasionally it can represent a bigger problem that needs evaluation and treatment.
If you have new or worsening trouble passing urine, contact your care team.
These are quite rare, but serious potential side-effects. Hallucinations are:
Seeing things that others don’t see
Hearing things that others don’t hear
Having difficulty knowing what’s real and what’s not
If you experience any of the following symptoms, call your care team right away.
Opioid use disorder is when a person has a powerful urge to take opioids to feel relaxed, happy or “high,” and not simply for pain relief. People with addiction often use opioids in unsafe ways, and have trouble controlling their opioid use.
Tolerance describes how a person’s body gets used to the effects of opioids, so that over time they may need a higher dose to get the same pain relief. Although common, this does not mean that a person is “addicted” to opioids or has opioid use disorder.
Dependence happens when a persons’ body naturally adjusts to opioids over time. If that person stops taking opioids suddenly, they will have withdrawal symptoms like achiness, belly cramps, nausea, and diarrhea. These symptoms are temporary and usually go away after a week or so. Your care team can help you avoid withdrawal by slowly tapering your opioid medications, instead of suddenly stopping them.
Opioid addiction is a treatable medical disease caused by many factors including genetics, family history, trauma, psychological health, and prior substance abuse. Taking opioids for cancer pain is unlikely to cause addiction by itself. People with opioid use disorder often have strong cravings to use opioids, even if their pain is under control. They often use more opioids than they need to control their pain, and opioids often cause problems with their life at home or at work. People with opioid addiction continue using opioids despite serious harm to themselves and others close to them.
Taking more opioids than prescribed
Taking opioids in order to feel “high,” relaxed, or happy – not simply for pain relief
Borrowing or taking opioids from other people
Buying opioids illegally (online or on the street)
Craving opioids or the good feelings it causes
Continuing to take opioids even when it causes serious problems like losing a job, an important relationship, or getting into trouble with the law
Talk to your care team about your worries. They can help you understand your personal risk and come up with a plan to lessen any risks of opioid pain medications.
If you find yourself turning to opioids or other medications to manage difficult emotions, reach out to a social worker or therapist for support. They can help you find better coping strategies.
Make sure to talk to your doctor if you have a history of addiction or problems with opioids, alcohol, cocaine or other substances. Being open about your history can help your care team come up with the safest and best plan for your pain management.
People with a history of opioid addiction may have cancer pain and need pain management. Having a specialized pain management team, such as through palliative care, can be helpful in coming up with the best pain management approach. This may include opioids, or it may not.
Addiction isn’t always so black and white. If you feel concerned about your opioid use, talk to your doctor or ask to meet with a psychologist. They can help you find tools to find pain relief while staying safe with opioids.
Sometimes friends and family members worry about addiction, even when their loved one isn’t showing any signs of addiction. These worries may cause friends or family to try to limit how much pain medicine their loved one takes. This can be a difficult experience for everyone. If your friends or family’s worries about addiction are making your pain management more challenging, have an open conversation with your care team. They can work with your family and friends to understand your situation and better support you.
Tap to learn more about lactulose.
Every 48 hours means that you will take off your old patch and put on a new one every other day
Every 72 hours means that you will take off the old patch and put on a new one every third day.
You should take your medicine three times per day. This DOES NOT mean to take it at breakfast, lunch and dinner. To be safe, you need to space each dose out by 8-hours. (Meals are only 4-6 hours apart).
Here are some schedules that work for every 8-hour dosing:
8AM, 4PM, midnight
7AM, 3PM, and 11PM
6AM, 2PM, and 10PM
If an 8-hour schedule is too hard, it may be safe to take your morning dose up to an hour late, or your evening dose an hour early. Talk to your care team if every 8-hour dosing does not work for your daily life.
You should take your medicine twice per day. This DOES NOT mean to take it when you wake up and at bedtime, or at breakfast and dinner. The doses need to be spaced apart by 12 hours. If you go longer than 12 hours between doses, the long-acting opioid will wear off and you will start to have more pain.
Here are some examples of every 12-hour dosing:
6AM and 6PM
7AM and 7PM
8AM and 8PM
Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take.
For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for breakthrough pain.
Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed.
If your pain is severe, start with the higher dose (for example: 2 tablets).
If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
These medicines start get into your system very soon after taking them. They usually wear off in about 12 hours.
Fentanyl patches take time to absorb through your skin, so it can take up to a day for it to get fully into your system. For this reason, if you are just starting this medication (or increasing the dose), you won’t feel the full effect for about a day. The patch usually starts to wear off after 3 days, which is why most prescriptions say to change the patch every 72 hours. If you take your patch off sooner than this, it will wear off in about a day.
Methadone isn’t a “slow release” version of an opioid, but it stays in the body for a long time. For this reason, it is used like other “long-acting” opioids to get predictable, long-lasting pain control. Most people will notice pain relief about an hour after taking methadone. It will take 3 days before you feel the full effect of methadone, when the medicine reaches what’s called a “steady state.” Until you get the full pain relief from methadone, you may need to use your short-acting opioid more often to control your pain.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
This can make your body absorb the medicine too quickly, which is dangerous.
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
Instead of a pill organizer or other container, keep your medicine in its original bottle. This helps you keep track of how much you are using. It also helps prevent medication errors, like taking the wrong pill by accident.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
Instead of a pill organizer or other container, keep your medicine in its original bottle. This helps you keep track of how much you are using. It also helps prevent medication errors, like taking the wrong pill by accident.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
Instead of a pill organizer or other container, keep your medicine in its original bottle. This helps you keep track of how much you are using. It also helps prevent medication errors, like taking the wrong pill by accident.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
More than this can put you at risk for severe problems including seizures.
Instead of a pill organizer or other container, keep your medicine in its original bottle. This helps you keep track of how much you are using. It also helps prevent medication errors, like taking the wrong pill by accident.
Read the instructions carefully and ask your care team if you have any questions. Do not use more patches than prescribed.
A rise in body temperature can also make the fentanyl absorb into your body too quickly. This can be very dangerous.
If the patch gets too warm, fentanyl can absorb into your body too quickly, which is dangerous. It’s best to avoid the following:
Hot baths or hot tubs
Sunbathing or tanning beds
Heating pads or saunas
Do not tear the patch or make any holes in it. Damage to a patch may allow fentanyl to pass into your skin too quickly. This can be very dangerous and cause an overdose
Do not touch the sticky side of the patch with your hands. If any of the medicine does get on your hand, rinse the area right away with a lot of clear water. Do not use soap or other cleansers.
Avoid driving while using this medicine. Until you see how it affects you, also avoid other tasks or actions that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, including sedation and slowed breathing. For this reason, it’s best to avoid alcohol while taking opioids.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
This can make your body absorb the medicine too quickly, which is dangerous.
Several types of medicine interact with methadone and can put you at risk for extra side effects. If you are prescribed a new medication, always make sure the doctor knows you are on methadone. Your doctor will know how to manage these “drug interactions.” They can be managed through extra monitoring, or by changing the dose of your medicines. Here's a list of common medications that interact with methadone:
Antibiotics: ciprofloxacin (Cipro), levofloxacin (Levaquin), erythromycin, azithromycin (Zithromax, Z-Pack)
Anti-nausea medicines: odansetron (Zofran), palonosetron (Aloxi)
Anti-fungal medications: fluconazole (Diflucan), voriconazole
Blood pressure and heart medications: verapamil, diltiazem (Cartia, Cardizem)
Antidepressants, anti-anxiety, and other psychiatric medicines: Paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), diazepam (Valium), quetiapine (Seroquel), haloperidol (Haldol), olanzapine (Zyprexa), carbamazepine (Tegretol)
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
Always follow the prescription instructions and call your care team if you have any questions.
Because Fioricet ® can sometimes cause sleepiness and dizziness, do not drive until you know how you feel on this medicine. Remember, most states do not allow people to drive if they are taking opioid pain medications.
Drinking alcohol while taking Fioricet ® can increase side effects like dizziness and sleepiness.
This medicine contains acetaminophen, so it’s important to be especially careful when taking other medications that may also contain acetaminophen.
This is a rule your doctor follows to keep you safe. Doctors prescribe a low dose of opioids to start. If needed, they slowly increase the dose until you find what works best for you. In the same way, the first time you take an opioid (or if your prescription is changed), you should always try the lowest dose first. For example: if your prescription says: “take 1 or 2 tablets as needed for pain,” start with one tablet. If you tolerate it, the next time you need pain medicine it is okay to try the higher dose.
If possible, it is best to have company the first time you take a new opioid medication, just in case you have a side effect you didn’t expect. Also, it’s best to take the opioid medication at least a few hours apart from any other medication that might cause drowsiness.
Over time, our bodies can get used to opioids, and we may need more medicine to get relief. This is called tolerance. If this happens, don’t increase your medication on your own. Work with your care team to find the dose that works for you and stick to that dose.
Also, if you find that your pain gets a lot better, don’t stop taking your opioids without talking to your care team. Stopping your opioids suddenly can cause you to go into withdrawal. Symptoms of withdrawal include diarrhea, vomiting, pain, and flu-like symptoms. Talk to your care team to create a safe plan if you are interested in lowering your opioid dose or trying to get off of it.
The bottle labels can be confusing. Make sure to ask your doctor, nurse, or pharmacist if you have questions about the instructions.
Although weekly pill organizers can be very helpful for some medications, you should keep your opioids in their original bottle. It is easy to get pills mixed up with each other and accidentally take the wrong amount.
This makes your body absorb the medicine more quickly, which can be dangerous. Talk to your care team if you are having trouble swallowing your pills.
A good rule of thumb is if you are no more than 2-3 hours late taking your long-acting opioid, go ahead and take it as soon as you realize that you have missed the dose. If you are later than this, talk to your care team about what to do. They might have you take your missed dose, and they may also instruct you to reschedule your next scheduled dose.
Correct! Emma is constipated. Since Emma is taking opioids, she should also be on a daily laxative regimen to prevent constipation. Tap here to learn more about laxatives.
She should also pay attention to her bowel movements and adjust her laxatives, aiming for a good bowel movement at least every day or two.
Try again. Stopping opioids will cause her pain to get worse, and she may also experience symptoms of withdrawal. The side effect of constipation can be effectively controlled with laxatives.
Try again. You may be thinking that it’s not a big deal to feel bloated, uncomfortable, or to not have a good bowel movement for a few days. With opioids, constipation can get out of hand quickly. It is important to treat it early with laxatives.
Way to go! As long as Julio is taking opioids, he should continue to take laxatives. These medicines go hand in hand. Tap here to learn more about managing constipation.
Try again. Even though Julio’s bowel movements are regular, he can quickly become constipated again if he stops laxatives – creating a “yo-yo” effect. Daily laxatives are safe and strongly recommended.
Try again.
These are good ways to manage constipation. Drinking at least 8 cups of water per day and eating fiber-rich foods (like raw fruits and vegetables, oatmeal, or other whole grains) can help. Just remember, diet alone may not be enough. Dwayne still needs to take laxatives.
You got it! This would not be a good idea.
It’s confusing - but fiber supplements can make constipation worse by making stools bulkier and harder to pass. For people taking opioids, experts recommend avoiding fiber supplements (like Metamucil) all together. Tap here to learn more about laxatives.
Try again. Dwayne may want to use this strategy to manage constipation.
One of the main ways Dwayne can stay regular is by increasing the dose of his daily laxatives (for example, Senna) when he starts to get more constipated. Once his bowel movements return to normal, he can try to go back to his old laxative routine.
Try again. This can actually be a good way to get his bowel movements back on track.
In addition to their daily laxatives, it can be helpful to take an extra medicine like a cap full of milk of magnesia, a packet of Miralax®, or bisacodyl (Dulcolax®). Once Dwayne's bowels get moving again, he can go back to his normal laxative routine.
Ouch, Try again!
Remember, Julio can to take up to 10mg every 3 hours. He’s already waited an hour, and his 5mg dose hasn’t helped. He should go ahead and take the other 5mg he’s allowed to have now.
Perfect!
It is safe for Julio to take up to 10mg every 3 hours. His pain medication should have started working by now. Since he isn’t feeling much relief, he should take another 5mg tablet. Tap here to learn more about the best ways to take your short-acting opioid.
Try again. Emma already took the largest dose allowed on her prescription. This dose hasn’t worked, so she needs to talk to her care team about what to do next.
Right!
Emma’s short-acting opioid medicine isn’t working. Her care team will want to know this so that they can make sure there is nothing more serious going on. If needed, they may adjust her medications to help her feel better.
Tap to learn more about the best ways to take your short-acting opioid.
Not quite. Remember, long-acting opioids minimize pain by keeping a low, steady dose of medicine in your system all the time. Dwayne’s pain is under good control because his long-acting opioids are doing their job. Stopping out of the blue could worsen his pain and could cause symptoms of withdrawal.
Spot on! Dwayne should continue to take his long-acting opioid, because it is working in the background to keep his pain at bay.
Tap to learn more about using your long-acting opioids to manage pain.
There's a better option. He could do this, but he would likely experience more pain throughout the day.
Great thinking! He should take his long-acting opioid now.
As long as Julio is only 2 or 3 hours late with his long-acting opioid, it is okay to go ahead and take this medicine. f he was more than 3 hours late, he should check with his care team for advice.
Tap to learn more about long acting opioids.
CORRECT!
Short-acting opioids are meant to help with pain spikes. Remember they take about 30 minutes to start working, and 1.5 hours to provide maximal relief.
Tap to learn more about the differences between short- and long-acting opioids.
Try again!
Emma is having a pain spike. Remember, long-acting opioids slowly release low doses of medicine. This means they will not work on a pain spike. Hopefully Emma has already taken her long-acting opioid at the normal time.
Try again.
Remember, short-acting opioids wear off in 3-4 hours and peak around 1 ½ hours after taking them. This means if Julio takes them at 2:30, they will be wearing when he is cooking.
Way to go!
Remember, short-acting opioids take about 30 minutes to start working, and 1.5 hours to reach their peak. Taking a short-acting opioid about 30 minutes before a painful activity is a good way to prevent pain and do activities you care about. Tap to learn more about when to take your short-acting opioids.
So close.
You may be thinking that it’s unsafe to take both short and long-acting opioids at the same time. Actually, this is perfectly fine and safe. It’s important for Dwayne to take both his long-acting opioid on schedule, and his short-acting opioid to help him sleep.
You’re on a roll!
He should take his long-acting opioid as planned, but alone this won’t be enough to get his pain under control. The short-acting opioid will take care of the pain spike, while the long-acting will work in the background to prevent more pain while he sleeps.
Tap to learn more about taking short- and long-acting opioids together.
That’s right!
The fact that Emma’s pain is better means that her long-acting medicine is working as it should. She should keep taking it regularly and use her short-acting medicine if she feels her pain worsening.
Tap to learn more about taking short- and long-acting opioids.
Try again!
Stopping the long-acting opioid could cause Emma’s pain to get out of control. Because Emma’s body is used to her long-acting opioid, stopping out of the blue could cause symptoms of withdrawal. She should keep taking it. If her pain stays under control for longer, Emma can talk to her doctor about safe ways to weaning down on her opioids.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
Instead of a pill organizer or other container, keep your medicine in its original bottle. This helps you keep track of how much you are using. It also helps prevent medication errors, like taking the wrong pill by accident.
Ask your care team if you have any questions about the instructions. Do not take a higher dose or take it more often than prescribed.
This can make your body absorb the medicine too quickly, which is dangerous.
Avoid driving while taking opioids. Until you see how it affects you, also avoid other tasks that call for you to be alert.
Drinking alcohol puts you at risk for dangerous side effects from opioids, like sedation and slow breathing.
Never take a higher dose of your opioids, or take them more often than prescribed. Instructions on medicine bottles can be confusing. Short-acting opioids are often prescribed with a range of doses you can take.
For example: “Take 1-2 tablets every 3 hours as needed for pain.” This means it’s OK to take up to 2 tablets within a 3-hour time window. You can also choose to take less than this, or not take it at all (if your pain is controlled). Take them with a sip of water, with or without food.
These take about 30 minutes to start working and 1 ½ hour to get the most relief, so take them early on when you feel your pain creeping up.
If your pain is manageable and you don’t expect it to get worse, you shouldn’t take this medicine. It should be used “as needed” when you have pain.
Try to “stay ahead” of your pain by taking your short-acting opioid early on when you notice your pain getting worse. If you wait until your pain is severe, it often takes more medication and a longer time to get your pain under control. Pay attention to your body as you learn about your pain and how you react to opioids. Most people start recognizing their body’s signals about when they need to take their short-acting opioid for break-through pain.
Most short-acting opioid prescriptions have a range of doses you can choose to take within a given time-period. A common example is take 1-2 tablets every 3 hours as needed.
If your pain is severe, start with the higher dose (for example: 2 tablets).
If your pain is less severe, you can start with the lower dose (for example: 1 tablet). If your pain isn’t significantly better after 30 minutes to an hour, you can take the rest of the dose.
Some people know they will have pain with certain activities, like walking or taking a long car ride. Think of activities that usually worsen your pain. To help you be more active, you may want to take your short-acting opioid 30 minutes beforehand.
Every person is different and it can take some time to find the right medicines and right doses for you. Your care team might decide to increase the dose of your opioid or change to a different medication. The important thing is to let them know how you are doing.
