Treating Pain with Medication

Approved by the Cancer.Net Editorial Board, 07/2016

Many people with cancer experience pain during or after treatment. However, your health care team can help you manage nearly all cancer-related pain.

Relieving side effects is an important part of cancer care and treatment. Talk with your health care team about any symptoms of pain you experience. This discussion should include any new symptoms or a change in symptoms. Members of your health care team will develop a plan to relieve pain and other side effects. This approach is called symptom management, supportive care, or palliative care. Sometimes, your health care team will consult with doctors who specialize in palliative care.

The importance of pain relief

There are different types of cancer pain. Pain may last just a short time and be triggered by a procedure or treatment or a position or movement. Pain may only occur from time to time. Or, pain may be long-lasting and constant. Pain may also increase suddenly even though it is being treated. This is called breakthrough pain. Breakthrough pain typically occurs between scheduled doses of pain medicine. It is not necessarily linked to a specific movement or time of day.

No matter what type of pain you experience, it is crucial that you tell your doctor, nurse, or another member of your health care team. Some patients do not want to tell their doctor they are experiencing pain. They may think the pain means that the cancer has worsened or spread. Others feel like pain is simply a part of living with cancer and that they should not complain. Although these thoughts are understandable, there are many reasons pain occurs. Every patient has the right to live with as little pain as possible.

It is important to remember that if you do not address cancer-related pain, it can make other symptoms or side effects of cancer seem worse. A person may also experience unnecessary fatigue, depression, anger, worry, or stress. Finding a solution will help you remain active, sleep better, and improve your appetite. It will also help you enjoy activities and time spent with your family and friends.

Common pain management concerns

Some patients worry about becoming addicted to pain medication. This is a valid concern, but it is uncommon if medication is used appropriately. Your health care team is trained to carefully monitor people taking pain medication. And they can help safely decrease your dose when you no longer need treatment. If you or family members have a history of alcohol or drug abuse, tell your doctor. By knowing ahead of time, your doctor can help you prevent a problem from developing.

It is also normal for patients with cancer to worry about the side effects of medications. Although some medications, particularly those for moderate or severe pain, cause side effects such as constipation, nausea, sleepiness, or confusion or hallucinations, not everyone experiences them. If you are concerned about a specific side effect talk with your doctor about whether it is manageable or if there are other pain management options. Also, if a side effect does not go away tell your doctor. Changing the timing, dose, or type of the medication may help.

Types of pain-relief strategies

After thoroughly assessing your pain, your doctor will help you develop a pain-relief plan. Some hospitals have pain specialists and palliative care specialists. These experts focus on the physical and emotional side effects of cancer. They help patients who have pain that is hard to control.

Doctors can treat or manage cancer-related pain in different ways:

  • Treating the source of the pain. For example, a tumor putting pressure on nerves can cause pain. Removing the tumor with surgery or shrinking it with radiation therapy, chemotherapy, or other medications could reduce or eliminate the pain. 

  • Changing the perception of pain. Some medications change how your body feels pain, making it more tolerable.

  • Interfering with pain signals sent to the brain. If medication does not work, your doctor may need to refer you to a pain specialist for specialized medical procedures. These include spinal treatments or pain medication injected into a nerve or tissue surrounding a nerve to interfere with a pain signal.

Medications for pain

Preventing pain from developing or getting worse is one of the most effective ways to treat cancer-related pain. When using medication to treat pain, patients usually receive it at regular, scheduled times. Taking or receiving pain medications regularly is important because it helps maintain a steady level of medicine in the body. This is the most effective way to relieve pain. Then, doctors also use “rescue” or extra doses to help control breakthrough pain if it occurs. Your doctor will look at the amount of medicine used for breakthrough pain at every visit and adjust your usual dose if needed.

Many different pain-relief medications, called analgesics, are available. Depending on the drug and the patient’s condition, doctors give them in different ways. Some are taken by mouth, while others are injected into a vein or worn as a skin patch.

  • Non-opioid pain relievers.These may be options for mild or moderate pain. Doctors also sometimes prescribe them along with other pain medicines for severe pain. These include the following:

    • Non-steroidal anti-inflammatories (NSAIDS), such as ibuprofen (such as Advil and Motrin)

    • Acetaminophen (such as Tylenol)

  • Medications commonly used for other conditions.Some medications used for other health conditions may help relieve pain, particularly nerve pain. These include:

    • Some antidepressants, such as duloxetine (Cymbalta)

    • Medications to prevent seizures, such as gabapentin (Gralise, Neurontin) and pregabalin (Lyrica)

  • Opioids, also called narcotics.They are often taken along with non-opioid medications. Opioids include the following, each of which has multiple brand names:
    • Hydrocodone

    • Fentanyl

    • Hydromorphone

    • Methadone

    • Morphine

    • Oxycodone

    • Oxymorphone

    Doctors may consider using opioids in some people with cancer when other options have not worked. Because of the risk of abuse, by the patient or those close to him or her, doctors will likely ask about these potential risks. It is very important that patients and caregivers store these securely so other people cannot get them. If someone uses them without a medical reason, serious side effects and even overdose can happen.

  • Medical cannabis (marijuana) or cannabinoids. Several states have approved the use of cannabis and cannabinoids for chronic pain. Currently, there is not enough evidence for ASCO to recommend cannabis as an initial option. However, if it is legal in your state, it may be an option along with other methods for unrelieved pain.

Medication is not the only option for controlling pain. Some patients also find physical therapy helpful in reducing pain. In addition, other methods are available, including complementary therapies. These include different techniques and methods to help ease the discomfort of many physical and emotional symptoms, ranging from mindfulness practice to acupuncture. The most complete and potentially successful approach to pain control often combines several methods. Learn about additional ways to manage pain.

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