Hi Eileen,
the downside of sudden, aggressive pain management is nausea and loopiness. I don't think it is possible to avoid that. Much of that should go away after the tolerance thresholds are hit. Simply put, opioids literally substitute some of the brain chemistry, so there is always an adjustment period while things rebalance themselves (this is why there is always a withdrawal from narcotics while the process is reversed). Patches (Fentanyl) are great, especially if swallowing is an issue but they take 24 hours to come up to speed.

Some people's body chemistry simply won't work with some drugs so they may have to fiddle with it a bit.

There are 2 basic classes of pain meds:

Long term, such as Fentanyl, Oxycontin. Methadone, etc. which are used to medicate the "normal" expected daily pain.

Short term, fast acting, such as Morphine, is used for breakthrough pain where relief is needed in 15 minutes (orally) or faster by injection or pump.

There are specific guidelines for cancer pain management on the NCCN site. Print the doctors a copy. Demand adequate pain management - use the scale in the NCCN guidelines to describe it -The doctors and nurses usually understand that.

Everybody reacts differently. I was on the patch for months and other than constipation (which is a side effect of all pain meds), had no problems with it.