Make Every Day Count
Helpful information for family caregivers
Side Effects of Pain Medication
Using medicines is the most common strategy for relieving pain. Over-the-counter choices include aspirin, ibuprofen, or acetaminophen.
Doctors also prescribe painkillers such as morphine. These stronger types of medication, known as opioids, are available in several forms: pills, liquids, patches, suppositories, pumps that inject a small quantity under the skin, and fluids that are delivered through an IV.
Although prescription medicines are very effective, they often cause side effects. Consulting with the patient’s doctor will help identify the type of medication and dosage that will work best. Pinpointing the best solution may take some trial and error.
Below is a list of the most common side effects caused by opioids and things you can do to help the person you care for relieve them.
Drowsiness, confusion or delirium
With all drugs, there is a trade-off between the benefit of the drug, and the side effects that come with it. Feeling sleepy is a common side effect of opioids. Often the pain has made it difficult to sleep, so some of that sleepiness is about “catching up.” After a week, sleepiness should not be as big of a problem.
Be careful in the beginning to be sure that the drowsiness does not pose a danger. In addition to sleepiness, some patients experience confusion or delirium. (Delirium involves restlessness, confused or garbled speech, and sometimes seeing things that aren’t there.) Watch to see how intense your loved one’s reactions are before using opioids in situations where he or she needs to stay alert for safety reasons (for example, driving).
Here are some things you can do to reduce drowsiness, confusion or delirium:
- Ask for a smaller dose, or an extended release version.
- Are other medications contributing to the problem? Many drugs list drowsiness as a side effect. Some may cause confusion or delirium, especially in combination with opioids. Are there any that of these medications that could be modified?
- Is the pain relief adequate? Pain itself is tiring. It may be that the medicine you are on is not taking care of the pain well enough. Perhaps you need a different medication?
- Is a mild stimulant appropriate? Ask the health providers if caffeinated beverages would be okay? Is there anything over the counter that might help?
- Call the doctor if the symptoms are bad, or come on suddenly after being on the medication for a week or more.
Constipation
Constipation is quite common. Opioids slow muscle movement, including the muscles of the intestines. Stool sits in the bowel longer, so more water gets absorbed. The stool then gets hard and difficult to pass.
Here are ways you can avoid or prevent constipation:
- Drink plenty of fluids. 8-10, eight ounce glasses of water or non-sugar, non-caffeinated beverages per day.
- Ask for a stool softener or laxative. Find out what preparation the doctor recommends.
- Eat high fiber foods when possible. These include vegetables, uncooked fruits (with the skins) and whole grains.
- Sprinkle bran on food. Adding 1-2 Tablespoons per day (along with drinking lots of liquid) can help keep the bowels moving.
- Exercise when possible. Walking is the easiest exercise. Any movements that encourage action in the abdomen will help.
- Sit upright to go. People who use a bedpan have more trouble with constipation than those who can walk to the toilet and sit upright. Consider a bedside commode if walking is too difficult.
- Call the doctor if you go for more than 2 days without a bowel movement.
Nausea and vomiting
As a general rule, nausea and vomiting will go away after a few days, once the body has adjusted to the opioids.
- Ask for medicines to help with nausea. There are medications designed specifically to reduce nausea and vomiting.
- Ask about modifying the dose. Perhaps you can take less, but more often. Or maybe an extended-release version would with fewer side effects.
- Is there a pattern? Some people, for instance, notice that the nausea is worse if they are up walking around the first hour or two after taking the medication. In that case, it’s best to lie down for an hour afterwards to keep the nausea at bay.
- Is the pain adequately relieved? Sometimes pain causes nausea. It may be that you need to try a different medication.
- Are there other causes? Are there other medications that might be contributing to the nausea? Is nausea a symptom of the condition itself?