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Possible to live without pain medications?

Page last modified on: September 19, 2008

Question from Leticia: Once you start taking pain medications, is it impossible to live without them?: Answers —Neal Slatkin, M.D.: The major concerns regarding drug dependence, which some people call drug addiction, really relate to one category of medication, and that is narcotics or opiates. They are better known by the term opiates, although many patients and physicians refer to them as narcotics.

In general, people taking these medications who do not have a significant substance abuse history have little to fear if they are taking the medication for physical pain. We do recognize that opiate medications have other effects that people can come to desire over time, such as relaxation and relief from anxiety. And if they're having problems with insomnia, medications can induce a sense of sleepiness.

You should not take opiate medications to relax, to ease distress, or to get to sleep. The use of medications in that way often does cause problems of dependence. You should use the medication for physical distress, not emotional distress. Again, if you use the medications that way, then dependence/addiction are infrequently problems.; Jennifer Griggs, M.D., M.P.H.: Dr. Slatkin, do physicians assess their patients regularly for issues of addiction, or do we depend on our patients to alert us if there's a problem?; Neal Slatkin, M.D.: In the use of strong pain medications—again, I'm speaking here of the opiate or narcotic medications—there has to be a partnership between the physicians and the patients. The doctor should ask the patients about their medication use. One question that Michelle and I often ask patients is, "Besides relieving your pain, what else are these medications doing for you?"

If the patient asks themselves that question, or if the practitioner asks that question and the answer is, "It relaxes me," then that may be the primary reason they're using the medication—and that needs to be further evaluated.

Certainly, if you're on these medications long-term, you need to be on a long-acting medication, such as sustained-release morphine, sustained-release oxycodone, or transdermal fentanyl.

In addition, you may need to take a short-acting opiate, such as Vicodin, oxycodone, morphine, or fentanyl. The last medication is administered to patients on a stick, which they can rub inside the cheek of their mouth and absorb the medication directly into the blood stream. For that reason, it tends to work faster than the other medications in relieving pain.

On Wednesday, January 21, 2004, our Ask-the-Expert Online Conference was called Pain Management: Getting the Relief YOU Need. Neal Slatkin, M.D., Michelle Rhiner, N.P. and moderator Jennifer Griggs, M.D., M.P.H. answered your questions about the best ways to deal with the physical pain and discomforts associated with breast cancer and breast cancer treatment.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Neal Slatkin, M.D. is director of supportive care services and associate professor in the department of neurology at the City of Hope Cancer Center in Duarte, California.

Michelle Rhiner, N.P. is patient coordinator and department manager in the department of supportive care and palliative medicine at the City of Hope Cancer Center.

Jennifer Griggs, M.D., M.P.H. is a medical oncologist specializing in the treatment of breast cancer, with a a special interest in cancer survivorship, patient-physician communication, and quality of care for women with breast cancer.