Narcotic Analgesics (Opioids) for Breast Cancer Pain Management

Narcotic analgesic drugs called opioids are often used to treat moderate to severe pain caused by breast cancer or breast cancer treatments. 

Opioids work by attaching themselves to opioid receptors located on cells in the brain, the spinal cord, and other areas of the body, blocking pain signals. Opioids also activate the release of dopamine, a brain chemical that produces feelings of calm and relaxation. Over time, opioids may stop working for some people, and they present risks, some of them significant.

Most opioid medicines are prescribed in long-acting forms, which may be labeled as such (long-acting or LA), or as extended-release (ER), controlled release (CR), or sustained release (SA). All long-acting opioids release a little bit of medicine over a period of time, which is how they work to control pain. There are also immediate-release (IR) forms of the drug that are short-acting, meaning you get a dose quickly over a short period of time. These are most often used to treat sudden or breakthrough pain.

Here are forms of opioids that are commonly used for breast cancer pain:

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  tramadol (Ultram): often used with non-steroidal anti-inflammatory drugs (NSAIDs) for moderate pain

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  hydromorphone (Dilaudid): available as an immediate release for pain relief for up to 3 hours, and also available as a sustained-release pill that controls pain for up to 12 hours

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  methadone (Dolophine, Methadose): works similarly to morphine and is used to treat severe cancer pain

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  morphine (Apokyn, Avinza, Kadian, MS-Contin, and others): available as an immediate release for pain relief for up to 3 hours, and also available as a sustained-release pill that controls pain for up to 12 hours

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  oxycodone (OxyContin, OxyIR, Roxicodone): available as an immediate release for pain relief for up to 3 hours, and also available as a sustained-release pill that controls pain for up to 12 hours

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  hydrocodone: comes as an extended-release capsule that you take once every 12 hours or an extended-release tablet that you take once daily

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  oxymorphone (Opana): available as an immediate release for pain relief for up to 3 hours, and also available as a sustained-release pill that controls pain for up to 12 hours

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  fentanyl (Actiq, Duragesic, Fentora, Lazanda, Subsys, and others): comes as a tablet, film that dissolves on the tongue, or spray, as well as a patch for the skin.

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  tapentadol (Nucynta): often used with non-steroidal anti-inflammatory drugs (NSAIDs) for moderate pain

As is true of all drugs, opioids come with some side effects, some mild and tolerable, others more problematic. Always discuss risks and side effects with your doctor, who may be able to adjust your dosage, suggest a different form of opioid, or prescribe other drugs to help ease side effects.

Not everyone experiences side effects from taking opioids, but for some, they can be serious.

This is a commonly reported side effect of opioid use, and for most people this effect is temporary, meaning it resolves over a short period of time. If you continue to feel excessively sleepy while taking opioids — for example, if it interferes with daily activities — tell your breast cancer care team.

Constipation is a frequently reported side effect of opioid use because the drug slows the passage of stool through the large intestine. This results in harder, drier stools and difficulty having a bowel movement. Your healthcare provider may prescribe a laxative or stool softener to ease this effect. You can also increase fluid and fiber intake and try to move around more. Other gastrointestinal side effects include nausea or vomiting, both of which tend to improve within a day or two, so talk to your doctor if it doesn’t or if it worsens.

These side effects may also crop up when you first start taking an opioid. Be sure to alert your doctor if they don’t improve within a day or two.

Higher doses of opioids may suppress breathing. Talk to your doctor if this affects you; a different dosage may work better.

Opioids also come with some significant risks, which is why sometimes doctors might prescribe them in combination with non-narcotic pain relievers.

Some people who take opioids find that they stop offering the same level of pain relief over a period of time. When your body gradually stops responding to the drug and either needs a larger dose or a different drug to get pain relief, it’s called tolerance. Tolerance is also called physical dependence, which is different from psychological dependence (or addiction).

Most patients who take opioids for cancer pain get relief and safely use the drugs without becoming psychologically dependent, which is addiction. Hallmarks of opioid abuse or addiction are psychological cravings for the drug, taking more than is prescribed or taking them in combination with other substances.

There is some evidence that the risk of breast cancer recurrence can increase with opioid use. ¹ This may be because opioids suppress immune function, among other reasons. 

Remember that breast cancer and treatments for the condition can often lead to various types of pain. No matter where you are in your treatment, it’s important to manage pain, both to promote physical healing and to maintain the best possible quality of life.

There’s no reason to suffer unnecessary pain. Always discuss your pain levels and pain management with your breast cancer care team. The goal should be to control pain with the most effective treatment for you that also comes with the least risk of side effects.