Moderate to Severe Persistent Pain

Narcotics, or opioids (pronounced OH-pee-oydz), provide the main relief for this level of pain. There are both long-acting and short-acting opioid pain medicines:

Long-acting opioids include:

• oxycodone (brand names: Roxicodone, OxyIR, OxyContin)
• fentanyl (brand name: Duragesic)
• morphine (brand names: MS Contin, Oramorph, Avinza, Kadian, Roxanol)
• methadone (brand name: Dolophine)

Short-acting opioids include:

• morphine (brand name: MSIR)
• codeine
• oxycodone (brand name: Percocet)
• hydrocodone (brand names: Vicodin, Vicoprofen, Lortab, Lorcet, Hycodan, Zydone)
• hydromorphone (brand name: Dilaudid)
• fentanyl—rapid acting (brand name: Actiq)
• meperidine (brand name: Demerol)

Dosage is adjusted to suppress your pain around-the-clock. Long-acting medication helps so that most of your day is pain free, and ideally you won't need to get up in the middle of the night to take another dose. Short-acting drugs are used to treat episodes of breakthrough pain.

There are many different opioids to try for pain relief, but all opioids have side effects. The more medication you take, the greater the side effects. Common problems include constipation, low energy (lethargy), nausea, and dry mouth. But these side effects are usually more tolerable than the pain and will lessen over time. Persistent problems can often be minimized with other therapies, such as laxatives, stool softener, anti-nausea medication, and stimulants.

You may fear that taking an opioid (narcotic) will make you a drug addict. It will not. Taking these medications as prescribed to treat your pain isn't addiction. Addiction is a disorder that makes people unable to control their drug use. It usually happens in people with a history of illicit drug use (street drugs) or people with a strong family history of addiction. You are "using drugs to live your life," not "living your life for drugs." There's a world of difference between the two!

Sometimes, people confuse drug tolerance—the need to increase the doses of medications to maintain pain relief—with addiction. You will not become immune to your opioids. Increased pain can be treated by increased opioid doses without any upper limit. Also, after weeks or months of treatment, it's possible to become physically dependent on pain medication, and you may have withdrawal symptoms if the dose is stopped suddenly. These problems can be addressed medically, once the source of the pain has been eliminated.

NSAIDs may be given in conjunction with opioids, especially for pain from arthritis or bone metastases. In addition, drugs called coanalgesics (pronounced koh-an-ul-JEE-ziks) improve the effects of both opioids and NSAIDs. These medications treat other conditions, but also benefit pain relief.

Depending upon what other medications you're taking, your doctor may prescribe one of these coanalgesics:

• tricyclic antidepressants
• anticonvulsants/antiseizure agents
• antihistamines
• steroids
• benzodiazepines
• bisphosphonates
• topical agents