Questions & Answers

Cancer patients rarely become addicted to powerful pain medications such as opioids when they are prescribed for cancer-related pain. The word "addiction" is widely misunderstood. Pain specialists view addiction as a series of specific behaviors involving compulsive use of medication, loss of control over medications, and insistence on taking medication despite deterioration in the quality of life. Patients usually become physically dependent on pain medication after taking opioids for more than twenty-four hours, but the physical dependence is a normal, expected part of proper pain treatment. Doctors and nurses slowly taper pain medication over time to ensure that patients do not experience severe withdrawal symptoms due to physical dependence. The risk of psychological dependence to analgesics is negligible with well-managed treatment. Patients with cancer very rarely seek drugs beyond what is needed to control pain.

The side effects of opioids and other analgesics have been well studied and can be managed effectively. To learn more about managing the side effects of cancer and its treatment, see our resource, Help with Fatigue, Pain, and Side Effects.

Depending on need, opioids may be prescribed at any stage of treatment. There is no need to "tough it out" early in treatment out of concern that strong pain medicines won't be effective if needed later on. Some people, but not all, develop drug tolerance, which means their body has become accustomed to the medication. When a medication doesn't relieve pain as well as it did, the dose can be adjusted or another type of medication or treatment can be prescribed. Patients may receive increasing doses of opioids for years without becoming addicted, or psychologically dependent. When the need for pain relief subsides, physical dependence can usually be managed without withdrawal symptoms by tapering the opioid before discontinuing.

A major priority of Memorial Sloan-Kettering's Pain and Palliative Care Service is the incorporation of the principles of palliative care into the care of all patients with cancer from the time of diagnosis, not only in the setting of advanced or terminal disease.

Palliative care treatment:

• Affirms life and regards death as a normal process.
• Neither hastens nor postpones death.
• Provides relief from pain and other distressing symptoms.
• Integrates the psychological and spiritual aspects of patient care.
• Offers a support system to help patients live as actively as possible until death.
• Offers a support system to help the family cope during the patient's illness and in their bereavement.