Medicines Used to Relieve Pain

The type of medicine and the method by which the medicine is given depend on the type and cause of pain. For example, constant, persistent pain is best relieved by methods that deliver a steady dose of pain medicine over a long period of time, such as a patch that is filled with medicine and placed on the skin (skin patch) or slow-release oral tablets. Below is an overview of the types of medicines used to relieve pain. More detailed explanations can be found later in the booklet.

For Mild to Moderate Pain

Nonopioids: Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. You can buy many of these over-the-counter (without a prescription). For others, you need a prescription. Check with your doctor before using these medicines. NSAIDs can slow blood clotting, especially if you are on chemotherapy.

For Moderate to Severe Pain

Opioids (also known as narcotics): Morphine, fentanyl, hydromorphone, oxycodone, and codeine. You need a prescription for these medicines. Nonopioids may be used along with opioids for moderate to severe pain.

For Breakthrough Pain

Rapid-Onset Opioids: Immediate-release oral morphine. You need a prescription for these medicines. A short-acting opioid, which relieves breakthrough pain quickly, needs to be used with a long-acting opioid for persistent pain.

For Tingling and Burning Pain

Antidepressants: Amitriptyline, nortriptyline, desipramine. You need a prescription for these medicines. Antidepressants are also prescribed to relieve some types of pain. Taking an antidepressant does not mean that you are depressed or have a mental illness.

Anticonvulsants (antiseizure medicines): Carbamazepine and phenytoin. You need a prescription for these medicines. Despite the name, anticonvulsants are used not only for convulsions, but also to control burning and tingling pain.

For Pain Caused by Swelling

Steroids: Prednisone, dexamethasone. A prescription is needed for these medicines. They are used to lessen swelling, which often causes pain.

How Is Pain Medicine Given?

Some people think that if their pain becomes severe, they will need to receive injections or "shots." Actually, shots are rarely given to relieve cancer pain. There are many ways to get the medicine.

• Orally — medicine is given in a pill or capsule form.
• Skin patch — a bandage-like patch placed on the skin, which slowly but continuously releases the medicine through the skin for 2-3 days. One opioid medicine, fentanyl, is available as a skin patch. This form of medicine is less likely to cause nausea and vomiting.
• Rectal suppositories — medicine that dissolves in the rectum and is absorbed by the body.
• Injections
  - Subcutaneous (SC) injection — medicine is placed just under the skin using a small needle.
  - Intravenous (IV) injection — medicine goes directly into the vein through a needle.
  - Intrathecal and epidural injections — medicine is placed directly into the fluid around the spinal cord (intrathecal) or into the space around the spinal cord (epidural).
• Pump

Patient-controlled analgesia (PCA) — with this method, you can help control the amount of pain medicine you take. When you need pain relief, you can receive a preset dose of pain medicine by pressing a button on a computerized pump that is connected to a small tube in your body. The medicine is injected into the vein (intravenously), just under the skin (subcutaneously), or into the spinal area.

If your pain is not well controlled with one of the long-acting oral medicines, if you are having trouble taking pills, or if you are having irritating side effects, ask your doctor about trying one of the methods listed above.

What Are the Side Effects of Pain Medicine?

Many side effects from pain medicine can be prevented. Some mild side effects that do occur, such as nausea, itching, or drowsiness, will usually go away after a few days as your body adjusts to the medicine. Let your doctor or nurse know if you are having these side effects and ask for help in controlling them.

More serious side effects of pain medicine are rare. As with the more common ones, they usually happen in the first few hours of treatment. They include trouble breathing, dizziness, and rashes. If you have any of these side effects, you should call your doctor right away.

You usually cannot take aspirin, ibuprofen, and other NSAIDs when you are on chemotherapy.

Which Medicines Will I Be Given?

In many cases, nonopioids are all you will need to relieve your pain, especially if you "stay on top of the pain" by taking them regularly. These medicines are stronger pain relievers than most people realize. For example, certain doses of opioids given by mouth are no more effective than two or three regular tablets of aspirin, acetaminophen, or ibuprofen.

If you do not get pain relief from nonopioids, opioids will usually give you the relief you need. Most side effects from opioids can be prevented or controlled. You should discuss taking opioids along with nonopioids with your doctor, nurse, or pharmacist. The two types of medicine relieve pain in different ways. Aspirin, acetaminophen, or ibuprofen taken four times a day might help avoid or reduce the need for a stronger pain relievers.

Many people who take opioids can benefit from continuing to take regular doses of aspirin, acetaminophen, or ibuprofen.

Some pain medicines combine an opioid and a nonopioid, like aspirin or acetaminophen, in the same pill. Ask your doctor, nurse, or pharmacist how much aspirin or acetaminophen, if any, is in your prescription. They can help you figure out how much of these medicines you can take safely. Other classes of medicines, such as antidepressants and anticonvulsants, are also used to relieve certain types of cancer pain. A chart on page 30 lists these other classes of medicines, how they work, and their side effects.

Nonopioids

Nonopioids control mild to moderate pain. Some can be bought without a prescription. For detailed information on nonopioids, review the chart below.

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