FAST FACTS: Opioid Side Effects (Adverse Effects)

Side effects of common medication pain treatments can limit good pain control, especially in older adults who are physically vulnerable.

General Information:

• Older adults are more sensitive to side effects of medications
• Side effects should be anticipated when using pain medications
• Watch for dry mouth, constipation, excessive drowsiness, nausea, disorientation, lack of urine output, or a decline in breathing in and out
• Work with your family member’s healthcare provider to prevent and vigorously treat these side effects
• Opioids, which are prescription pain medications used for the treatment of moderate to severe pain, should start at a low dose and be slowly increased to minimize harmful side effects
• A routine laxative should be prescribed when opioid treatment is started. Laxative doses should increase when the opioid dose is increased.
• Tolerance is the body's normal response to continued exposure to a medication resulting in a reduction of the side effect over time. This applies to most opioid side effects, except constipation
• If side effects last for a long time, speak with your family member’s healthcare team to discuss treatment options

Overview of Common Adverse Effects to Opioid Pain Medication:

• Drowsiness and change in cognition (thought, understanding, awareness)
  • This generally improves within 72 hours of starting or increasing an opioid medication
• If drowsiness or decrease in cognitive function persists, report this to your family member’s healthcare provider who will review the situation.
• Decline in breathing in and out
  • Common fear, but actually very rare when opioids are used for routine persistent pain.  Note: changes in respiration at end of life are to be anticipated.
• Disorientation
  • Report to this to your family member’s healthcare provider to determine cause

• Nausea
  • Generally resolves within 72 hours of initiating a new pain medication
  • Non-drug treatments include:
    • Lie down
    • Take medication with food
    • Increase circulating air
    • Place a cool towel on head/neck
    • Do not eat foods at extreme temperatures
    • Avoid spices in foods
    • Avoid strong odors
  
• Constipation
  • The healthcare provider should prescribe medication to combat constipation along with opioid pain medications
  • Take medications for constipation as prescribed
  • If constipation persists, report to the healthcare provider, who will increase dose as needed
• Involuntary muscle twitching
  • Can occur with high doses of opioid therapy
  • Report to the healthcare provider
• Itching
  • Can occur with high-does opioid therapy
  • This is most common with morphine but can occur with other opioids.  For most people, itching is a side effect, not an allergy.
  • Report to the healthcare provider
  • Antihistamines are a common medication used for itching
  • Your family member may also benefit from cool compresses and/or moisturizers to sooth the itching

• What Else You Should Do
  • Report all information about adverse effects to their healthcare provider
  • Encourage your family member to use a Pain Diary to note important information (such as side effects) useful to the provider

References:

1. Used with permission of K. Herr, PI, Cancer Pain in Elders: Promoting EBP's in Hospices; NCI Grant R01CA115363; Adapted from AHRQ Grant RO1 HS 10482; M. Titler; PI; Revised 2/7/07.
2. Reuben DB, Herr KA, Pacala JT, et al. Geriatrics At Your Fingertips: 2021, 23rd Edition. New York: The American Geriatrics Society; 2021.