Medications should be given by the clock, not prn, since untreated pain escalates and may not then respond to the usual doses. Side effects can usually be anticipated, and often prevented, so as not to interfere with adequate pain control. Constipation is an almost inevitable consequence of chronic narcotic use and the only one to which tolerance does not develop. A rigorous bowel regime should, therefore, be initiated at the same time pain medications are started.
Nausea is an occasional side effect.
Sometimes, however, if the nausea is intractable, a different narcotic may have to be used. Respiratory Depression is virtually never a problem when using oral narcotics as outlined here. Addiction is a psychological pattern of drug use characterized by a continued compulsive craving for an opioid leading to an overwhelming involvement with the use and procurement of the drug. It is extremely rare in patients with pain. Physical Dependence , however, develops in all patients who have been on long-term opioids.