Cancer is overwhelming. While treatments have improved radically over the course of the last several decades, there are still many things to navigate when you receive a cancer diagnosis.
One of the issues that affect as many as 55% of cancer patients during treatment is pain. Even after treatment, moderate to severe pain can continue in nearly 40% of cancer patients.
Cancer And Fentanyl Dependence
Fentanyl is a legal opioid that is a very effective treatment for cancer-related pain. However, it is also highly addictive.
Using fentanyl for an extended period can lead to opioid dependence. A person who becomes dependent on fentanyl may need to use higher doses of the drug or find illicit drugs once they can no longer access fentanyl.
It was previously believed that cancer patients almost never developed an opioid use disorder from using opioids like fentanyl for cancer pain. But, doctors are now discovering that may not be true.
Nevertheless, the relationship between fentanyl and cancer can be complicated. Patterns of behavior normally associated with drug-seeking may mean something different when it concerns a cancer patient.
What Causes Pain During Cancer?
Cancer-related pain can be debilitating. It can affect a person’s quality of life, ability to function, and other aspects of physical or mental health.
Cancerous tumors can sometimes cause pain through the release of chemicals into the body. But there are other sources of pain.
Location Of Cancer
The location of cancer in the body can have as much or more to do with a person’s pain level as the amount of cancer in the body.
If a small amount of cancer is located on a nerve or on the spine, it can potentially be more painful than a large amount of cancer found elsewhere in the body.
Additionally, cancer may cause pain if a tumor puts pressure on organs or bones as it grows.
Result Of Cancer Treatment
Pain can also be the result of cancer treatment lasting for years after treatment has finished.
A patient may experience pain as a result of the following:
- radiation treatment
Experiencing pain after treatments have finished does not necessarily mean that the cancer is returning or getting worse.
The Severity Of Cancer Pain
Cancer can be very painful and have consequences on the day-to-day activities of cancer patients as well as their mental health.
Cancer Pain And Daily Function
Cancer pain can often be location specific because of the presence of tumors. Pain of this kind can inhibit motion and movement.
As a result, cancer patients can experience the limitation of daily activities, making it very difficult to do things that normally would have been easy.
Cancer Pain And Emotional Health
Patients who experience constant pain that limits their activities and affects their quality of life can also experience a deterioration in their emotional health.
Chronic pain that is unrelated to cancer can cause people to feel anxious or sad and put them at risk for substance abuse as a way of coping.
Cancer patients already experience a host of negative emotions as a result of diagnosis and treatment. Add debilitating pain that doesn’t allow them to enjoy life like they used to, and the result can have devastating consequences for their mental health.
Breakthrough pain is best thought of as a sharp increase in pain above what the general level of pain may be in one particular area of a person’s body.
It has been estimated that about 75% of cancer patients who adequately treat existing pain (with a transdermal fentanyl patch or other methods) have breakthrough pain episodes.
It is this kind of pain that fentanyl was designed to treat orally or intranasally as needed.
Harm Reduction Strategies For Fentanyl Use In Cancer Patients
Harm reduction strategies are intended to reduce the potential negative consequences of taking fentanyl or other opioids.
If you are taking fentanyl for cancer-related pain, then read on to learn about strategies to reduce the risk of fentanyl dependence or addiction.
Note: The discussion of harm reduction necessarily brings up drug-seeking behavior and what to do in response to that behavior. However, signs of drug-seeking may be signs of other problems when in the context of cancer patients, problems that are unrelated to signs of an opioid use disorder.
Informed Consent With Fentanyl For Cancer Treatment
The first strategy to reduce the potential harm of fentanyl use is informed consent. Patients need to understand the dangers and risks of opioid use disorder as a result of long-term opioid use.
Researchers have found that while opioids are an effective pain management tool, they can paradoxically cause pain to increase over time as prolonged exposure to opioids such as fentanyl can lower a person’s pain threshold, increasing pain levels.
In addition, some of the uncomfortable or potentially life-threatening effects of using fentanyl may include:
- risk of opioid overdose
- respiratory depression
- nausea and vomiting
- urinary retention
It’s essential for medical professionals to make their patients aware of these serious effects and potential drawbacks.
Doctors should also inform their patients that opioids may not always be the best way to control pain. In addition, people who take opioids are at risk of developing mental health disorders and using opioids as a way of coping.
Informed consent represents not just a list of rules to follow but an opportunity for you and your physician to jointly discuss what you need and your pain management goals.
Understanding Risk Factors For Opioid Use Disorder
Patients should take time to understand the risks of opioid use disorder and determine whether they have any pre-existing characteristics or conditions that may put them at a higher risk of developing an addiction.
Doctors, for example, can administer a screening tool called the Revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R) to evaluate a person’s likelihood of substance dependence before prescribing fentanyl.
The SOAPP-R evaluates:
- personal and family substance abuse history
- untreated mental health disorders
- time spent in prison (if any)
- family and social factors
- negative childhood memories
Administering The Lowest Possible Dose
When taking fentanyl or any other opioid, doctors should start you off with the lowest dose possible.
For example, if prescribing oxycodone to a patient who has never used opioids before, a doctor should introduce the drug at 20 milligrams (mg) per day, the recommended starting dose.
This does not mean that the dose must remain there. Your doctor can adjust the dosage to address pain as needed.
But if a lower dose can address the pain that you experience, that’s ideal. This lowers the risk of a patient developing an opioid use disorder.
Take Fentanyl Through A Transdermal Patch
Studies have shown that taking a low dose of fentanyl through a transdermal patch (skin patch) can be an effective means of pain control.
A skin patch delivers a steady dose of the opioid for a period of time, potentially giving you an effective means to reduce generalized pain.
With this method, doctors also have the option of prescribing oral medication for breakthrough pain.
Taking Fentanyl As Directed
When taking fentanyl, oral or transdermal, you should take the medication exactly as prescribed. Fentanyl, as with all opioids, comes with a risk of overdose if you take too much of it.
Regular Addiction Screenings For Cancer Patients
The goal of screening a patient for addiction risk factors is to determine whether or not opioid pain relievers such as fentanyl are the best option.
Cancer patients, however, need to receive a degree of deference for the amount of pain they might be in. Doctors do not want to incite opioid use disorder but neither should they refuse pain treatment to people experiencing severe pain due to cancer or cancer treatment.
Regular Drug Screenings
Drug tests monitor the level of opioids or other drugs in the body. When conducting a drug screening, doctors look for metabolites in the urine that indicate a level of fentanyl or another opioid that is consistent with the amount they have prescribed.
With cancer patients, special care needs to be given to the possibility that patients may have taken more of an opioid because of an episode of severe breakthrough pain.
However, a patient should not go above the prescribed dose. Regular drug screenings can help ensure cancer patients are only using the prescribed dose of fentanyl.
If a urine test indicates a higher-than-normal fentanyl level, this may be indicative of misuse.
Periodic Pill Counts
Doctors may also assess whether the medication is being taken as prescribed by conducting periodic pill counts.
A patient may have fewer pills for the same reason as above, in which case it may be appropriate to begin a discussion around the potential for drug abuse.
Doctors may also prescribe low-quantity doses of fentanyl to prevent a patient from taking too high of a dose.
The potential drawback may be complications with additional doctors’ appointments; however, the potential advantages of safer fentanyl use may outweigh the drawbacks.
Having Access To Opioid Overdose Prevention Medications
One important harm reduction strategy is for cancer patients to have access to opioid overdose prevention medications.
If you are feeling poorly from treatment, it can sometimes be easy to take too much pain medication. Having overdose-prevention medication on hand can help reverse an accidental overdose.
Naloxone (sold under the brand name Narcan) is commonly used by both first responders and caretakers to reverse opioid overdose.
It comes in a nasal spray and in some states, you can purchase it without a prescription.
Nalmefene is another medication that can be used reverse respiratory depression in a fentanyl overdose.
Alternatives To Opioids For Pain Management Among Cancer Patients
Opioids are not the only pain relievers available to cancer patients. There are non-opioid pain relievers available over-the-counter in addition to other options.
You and your doctor should consider these first before resorting to opioids of any kind, including powerful ones such as fentanyl.
Non-Pharmacological And Non-Opioid Pain Treatments
Non-pharmacological pain treatments (treatments for pain that do not involve medications) can often provide relief or distraction from cancer-related pain.
These types of treatments may include:
- a warm washcloth on painful areas
- a warm bath
- ice or a cold pack if heat doesn’t work
- a gentle massage
If none of the above methods are effective, there are over-the-counter medications that may reduce your pain level.
Depending on what your doctor says, these may include:
Combination Drug Therapy Options
Doctors can sometimes prescribe non-opioid medications to take in conjunction with opioid medications such as oxycodone or morphine (medications that are safer yet often overlooked in favor of fentanyl).
The combination of some medications taken together or staggered can create effective pain treatment.
Coping Strategies For Cancer Pain
Chronic pain can affect your mental and emotional health. As you experience the deterioration of these things over the course of weeks or months, it becomes more difficult to cope with pain.
These strategies are proactive ways that you can cope with cancer-related pain.
Keep Your Oncology Team Updated On Pain Levels
It is critical that you keep your oncology team up to date on how you are doing. Be honest about your pain levels, if they are increasing or decreasing.
Sometimes you can build a tolerance to certain types of opioid medications. This may mean that you need to try another type of opioid or non-opioid pain reliever to treat the pain.
Keep A Pain Diary
Keeping a pain diary can help you in a variety of ways. In a practical way, it can help you keep track of different aspects of your pain so you can give your doctor an accurate picture of what is going on.
Use a pain diary to keep track of:
- your pain level in general
- things that cause your pain level to increase
- times of day or situations when you have breakout pain
- your pain level before and after you take medication
You can also use your pain diary to write down how pain is affecting you emotionally. This can provide an opportunity to process a host of negative emotions that you may be feeling.
Use Of Imagery And Pain
Using imagery helps some people cope with pain. It involves creating an image for healing or a person without pain and internalizing that image.
For example, you might picture healing as a glow that slowly expands through your body. Or you might imagine cutting the nerve signals to your pain.
Relaxation exercises can also be helpful. You can do them while sitting or lying down.
These types of exercises involve rhythmic breathing that is slow and allows you to incorporate imagery or focus on a positive statement that helps you calm your mind.
Treatment For Fentanyl Dependence
More and more people are living through cancer and emerging from treatment cancer free. In part because of this, there is an increase in post-cancer opioid use disorder.
The good news is that substance use disorders involving opioids can be treated.
Medication-Assisted Treatment (MAT)
Medication-assisted treatment is a common and often necessary approach to recovering from opioid use disorder.
MAT involves using opioid antagonists, partial agonists, or agonists to block the opioid receptors in the brain, manage withdrawal symptoms, and reduce cravings.
Medications used in this kind of treatment include:
- Evidence-Based Therapy
Medication alone is not enough to resolve an opioid use disorder. Pain in cancer patients and the ordeal of cancer treatment can create lasting trauma and a number of other mental health disorders.
Evidence-based therapies such as cognitive behavioral therapy, trauma-informed therapy, and others provide a way for people to uncover the roots of these issues and resolve them.
Resources For Cancer Patients Using Fentanyl
When considering pain and how to manage it, there is still more to know. The resources below provide thorough information on opioids, opioid treatment, managing pain through alternative methods, and other topics related to cancer pain and pain treatment.
These resources explore cancer pain and how to manage it:
- The American Cancer Society, Cancer Pain: A thorough and patient-focused resource on cancer-related pain and how to manage it.
- National Cancer Institute, Support for People with Cancer: Cancer Pain Control: This resource from the National Cancer Institute provides a broad overview of pain and different methods for managing it.
Use the following resources to learn about fentanyl, other opioids, their uses, and their risks:
- Medline Plus, Fentanyl: This resource comes from MedlinePlus and details a number of facts about fentanyl including its uses, forms, and dangers.
- The National Institute on Drug Abuse (NIDA), Opioids: NIDA provides this resource for learning more about opioids in general.
These resources can offer perspective on managing pain without pharmacology:
- National Health Service (NHS), Chronic pain self-management Relaxation: This resource from the NHS details several methods for relaxation as a tool to affect chronic pain.
- United States Department of Veterans Affairs, VHA Pain Management: Veterans and the general public can gain insight into managing chronic pain from this resource.
- Epworth HealthCare “Guided Imagery Practice For Pain”: This YouTube video provides instruction on how to use guided imagery for pain.
- University of Rochester Medical Center, Journaling for Mental Health: Learn how to journal effectively to improve mental and physical health.
Explore the resources below to learn about substance dependence and treatment:
- NIDA, Effective Treatments for Opioid Addiction: This fact sheet provides the basics of treatment for opioid use disorder.
- NIDA, Drugs, Brains, and Behavior: The Science of Addiction: This is a science-based resource for more information about how addiction forms.
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- American Cancer Society — Managing Cancer Pain at Home
- American Society of Clinical Oncology Educational Book 35 — Cancer Pain Management: Safe and Effective Use of Opioids
- BMJ Open — Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners
- Cancer Management and Research — Role of intranasal fentanyl in breakthrough pain management in cancer patients
- Cancer Research UK — About cancer pain
- Cancer Research UK — Fentanyl
- Current Opinions on Anesthesiology — Breakthrough pain in cancer patients: prevalence, mechanisms and treatment options
- Frontiers in Pain Research — Opioid Therapy in Cancer Patients and Survivors at Risk of Addiction, Misuse or Complex Dependency
- Journal of Clinical Oncology — US Trends in Opioid Access Among Patients With Poor Prognosis Cancer Near the End-of-Life
- Journal of Pain and Symptom Management — Emerging Opioid Abuse in Terminal Cancer Patients Taking Oral Transmucosal Fentanyl Citrate for Breakthrough Pain
- The Korean Journal of Internal Medicine — The efficacy of low-dose transdermal fentanyl in opioid-naïve cancer patients with moderate-to-severe pain
- Mayo Clinic — Cancer pain: Relief is possible
- National Center for Biotechnology Information — A Guide to Substance Abuse Services for Primary Care Clinicians: Chapter 2—Screening for Substance Use Disorders
- National Cancer Institute — breakthrough pain
- National Cancer Institute — Emotions and Cancer
- National Cancer Institute — Opioid Use Drops among Cancer Patients at End of Life
- National Cancer Institute — Support for People with Cancer: Cancer Pain Control
- Pain — When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function
- Translational Psychiatry — The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies
- United States Drug Enforcement Administration — Fentanyl