Managing pain safely at home: describing it, the schedule, side effects and safe storage

Pain is hard to watch and harder to live with. Much of what keeps it under control happens at home, in small habits: describing the pain well, giving medicine the way it was prescribed, staying ahead of side effects, and keeping strong medicines safe. For cancer pain, the National Cancer Institute’s message is plain: it can almost always be relieved.¹ This note covers how to describe pain, how to give pain medicine, what’s true about addiction, the side effects to expect, and how to store and get rid of opioids.

The short answer

• Tell the team what the pain feels like, where it is, how long it lasts, how strong it is and when it’s better or worse, and keep a pain diary.²
• Take pain medicine exactly as prescribed, without skipping doses or stretching the time between them; pain is easiest to treat early.²
• Pain medicine taken on a schedule keeps the level in the body steady, with extra doses for breakthrough pain if the doctor orders them.³
• Opioids cause constipation in most people, and it can often be prevented or controlled.⁴
• Tell the doctor before mixing opioids with alcohol, tranquilizers or sleeping pills: together they can cause extreme sleepiness, slowed breathing, coma and death.^4,5

Describing pain so it can be treated

The team can only treat the pain they hear about. MedlinePlus suggests telling the provider:²

• What the pain feels like: aching, dull, throbbing, constant or sharp
• Where you feel it
• How long it lasts
• How strong it is
• Whether there’s a time of day when it’s better or worse

The provider may ask you to rate the pain on a scale or a chart. A pain diary helps: write down when the medicine was taken and how much it helped.² Bring the diary to visits, and keep it where everyone who gives care can add to it.

Giving pain medicine the right way

Pain medicine works best when it’s given on a schedule, so the level in the body stays steady and the pain doesn’t get ahead of it. The doctor may also order extra doses for pain that comes between scheduled doses, called breakthrough pain.³ Take the medicine exactly as the provider says, and don’t skip doses or try to go longer between them.²

• Don’t change how much or how often the medicine is taken without talking to the care team first.⁴
• Tell the provider about every other medicine the person takes.²
• Don’t stop an opioid suddenly. If it’s stopped and flu-like symptoms or sweating follow, tell the team; tapering slowly helps.⁴
• Tell the provider when a medicine isn’t working, or when side effects show up.²

What’s true about addiction

Two words often get mixed up. Tolerance means that, over time, the same dose gives less relief; it’s a physical dependence, and it isn’t the same as addiction, which is a psychological dependence.³ Most people who are prescribed opioids for serious pain use them safely, though some can become addicted.³ MedlinePlus puts it simply: as long as you take the medicine as prescribed, you have little chance of becoming addicted.²

If anyone in the home has struggled with opioids or other drugs, tell the team. The care team may ask about it, and the plan for storing medicines can fit your home.⁴

Staying ahead of side effects

• Constipation. Opioids cause it in most people, and it can often be prevented or controlled, so the doctor may suggest a laxative or stool softener from the start.⁴
• Nausea. It usually goes away after a few days of taking the medicine.⁴
• Sleepiness. Don’t do anything that needs full alertness until you know how the medicine affects the person.⁴
• Confusion or seeing things. These are less common. Call the team if they happen.⁴

Breathing, and naloxone in the house

Taking too many opioids can slow or even stop a person’s breathing, and conditions like sleep apnea and COPD raise the risk.⁴ The FDA warns that opioids taken with benzodiazepines or other medicines that slow the brain, including alcohol, can cause extreme sleepiness, slowed or difficult breathing, coma and death.⁵

Naloxone is a medicine that rapidly reverses the effects of an opioid overdose.⁶ In 2023, the FDA approved the nasal spray for sale without a prescription, in places like drugstores, grocery stores and online.⁶ In California, prescribers must offer a naloxone prescription when a person takes 90 or more morphine milligram equivalents of an opioid a day, takes an opioid along with a benzodiazepine, or is at higher risk of overdose, and must teach the patient and the people they choose how to use it.⁷

The CDC lists the signs of an overdose: the person can’t be woken up, breathing is slow, shallow or sounds like choking, the skin is discolored, especially the lips and nails, and the pupils are tiny. Give naloxone if you have it, then call 911, and stay with the person until help arrives.⁸

Keeping medicines safe

Store opioids where no one else can get to them, such as a locked box, and never share them.⁴ When they’re no longer needed, get rid of them right away. The FDA’s first choice is a take-back option: a drug take-back location or a prepaid mail-back envelope.⁹ If a medicine is on the FDA’s flush list, which includes some opioids, and a take-back option isn’t available, flushing it is the next best choice.⁹ For medicines not on the list, mix them with something unappealing like dirt, cat litter or used coffee grounds, without crushing pills, seal the mix in a plastic bag, put it in the trash, and scratch out the personal information on the empty bottle.⁹

If the person is in hospice, follow the hospice’s written policy for medicines; Morphine and comfort medicines in hospice explains it. Keeping medicines straight at home after the hospital covers the medicine list.

Questions to ask the team

• Which doses are on a schedule, and which are only for breakthrough pain?
• How many extra doses in a day should make us call you?
• What’s the plan to prevent constipation?
• Should we keep naloxone at home?
• Who do we call at night when the pain isn’t controlled?