Constipation: the top complaint

The number one complaint of patients is constipation, which can come on quickly and become very uncomfortable. It can be worse for older patients who may already suffer from some degree of constipation.

The trick is to have patients on a "bowel regimen" before they start using opioids, says Eugenie Obbens, MD, the acting chief of the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City. That involves consuming more fiber and using bowel-stimulating products such as prunes and natural stool softeners.

Being smart about your meds
Although it's rare for chronic pain sufferers to become addicted—unless there's a past history of drug or alcohol abuse—it can be a red flag when patients begin to use painkillers to get them through emotionally difficult times.

When Dennis Botts, 55, a Pineville, La., resident, needed opioids such as Lortab (a combination of acetaminophen and hydrocodone) and morphine during his recovery from esophageal cancer surgery, he was careful to adhere to strict, self-imposed rules about when to take them.

As a former hospice worker and someone who had used painkillers to tackle pain in the past, he knew to rely on the drugs only for pain relief.

"Sometimes people want to escape," says Botts, "and not feel despair or pain, and maybe take something strong enough to nap all day. I think that might be one of the avenues for abusing your pain medication—using it for more than pain, for some of the emotional pain attached to it."

"I would try not to take the medicine if I was tired, irritable, or wanted to use it as a sleep aid. I tried not to take it in the morning just because I felt more uncomfortable in the morning and it would be easier to take something to get going."

Signs to watch out for
It's uncommon for most people to develop an addiction to properly administered narcotics, but it can happen. Here are some telltale signs of a potential problem.

• When a patient uses their medication for anything other than the treatment of pain. "You're using it because 'My mother-in-law just came in and I've had a bad day: I'm going to take some of my Percoset because I'll feel better,'" says Micke Brown, director of advocacy at the American Pain Foundation. "That's concerning."
• There's a craving for the drug or compulsive use of it.
• A patient is consistently using more than the prescribed amount—and not reporting it to their physician. Keeping secrets is one of the "really clear signs that the drug is controlling the person; the person's not controlling the drugs," says Brown.
• Use of a drug is getting in the way of time that would ordinarily be spent working, enjoying friends and family, or pursuing a hobby.