Different types of pain medicines are useful in treating different types or causes of pain. Opioids, non-opioids and other drugs may be used to manage pain related to cancer. Each type of drug helps control pain in different ways. They may be used alone or in combination. It may take a few weeks to find the right drug and dose to control pain with the fewest side effects.
Opioids are commonly used to treat cancer pain. The different types of opioids can be used to treat moderate and severe pain. Most opioid drugs are only available with a prescription. They may be given alone or with other drugs to relieve pain. The type and dose you take will depend on your pain level.
Opioids usually need to be taken on a regular schedule. Short-acting (immediate release or IR) drugs may be used for acute pain. They start to relieve pain fairly quickly, but for a shorter period of time (2 to 4 hours). Other drugs are long-acting (extended release or ER). Their dose is delivered over a longer period of time, often over 12 hours or more. These drugs are often used for chronic or constant pain.
Doctors often order a combination of short-acting and long-acting drugs. A short-acting drug may be prescribed to control any breakthrough pain felt between the scheduled doses of a long-acting drug. The amount of time between doses can vary depending on the specific drug and how well the drug is working. If several doses of drugs are needed to control breakthrough pain, the dose of the long-acting medicine may be increased.
Opioids used for cancer pain include:
- buprenorphine (Subutex)
- fentanyl (Duragesic)
- hydromorphone (Dilaudid)
- levorphanol (Levo-Dromoran)
- morphine (MS Contin, Statex, MOS)
- oxycodone (OxyContin)
- oxymorphone (Opana)
- tapentadol (Nucynta)
- tramadol (Ultram)
Specific drugs will have particular side effects, but common side effects of opioids include:
- nausea and vomiting
- dry mouth
- itchy skin
- difficulty urinating
- muscle jerks
- lowered breathing rate
Non-opioid drugs are used alone to treat mild to moderate pain. They may be given in combination with opioid drugs to relieve moderate to severe pain. These drugs can be short-acting (immediate release or IR) or long-acting (extended release or ER). Many non-opioid drugs are over-the-counter medicines and others are available by prescription.
Acetaminophen (Tylenol, Atasol) is commonly used to control mild pain and to reduce fever. Your doctor may not want you to take acetaminophen regularly if you’re getting chemotherapy because it can cover up a fever. There are usually no side effects from a normal dose of acetaminophen. Taking large doses every day for a long time can damage the liver.
Nonsteroidal anti-inflammatory drugs (NSAIDs) help control pain and reduce inflammation or swelling. They can help manage pain related to cancer that affects bones or soft tissues. You should not take NSAIDS if you are receiving chemotherapy or about to have surgery. Children and teens should not take Aspirin or products that contain it. NSAIDs can interact with other medicines. Talk to your healthcare team to make sure it is safe to take NSAIDs. They can also give information about what type and strength of drug might work best. NSAIDs used for cancer pain include:
- ibuprofen (Motrin, Advil, Nuprin)
- acetylsalicylic acid (ASA, Aspirin, salicylate)
- naproxen sodium (Aleve)
- celecoxib (Celebrex)
- ketoprofen (Orudis)
- ketorolac (Alti-Ketorolac, Toradol)
- fenoprofen (Nalfon)
- indomethacin (Indocin)
- nabumetone (Relafen)
- naproxen (Naprosyn)
- oxaprozin (Daypro)
- piroxicam (Feldene)
- sulindac (Clinoril)
Side effects are specific to the drug, but common side effects of NSAIDS include:
- upset stomach
- bleeding in the stomach
- problems with blood clotting
- kidney problems
Other types of medicine may be given along with opioid and non-opioid drugs to help control pain. These medicines are called adjuvant analgesics. They may not be specifically designed to relieve pain, but they may be given to help manage it. They are usually available by prescription and commonly taken orally (by mouth).
|Drug class||Common drugs used|
Anti-anxiety drugs may be used to treat muscle spasms, which can occur with severe pain.
Anticonvulsants may be used to treat nerve pain. They work by reducing the pain signals from damaged nerves.
Antidepressants may be used to help relieve nerve pain.
Antihistamines may be given along with pain drugs to help control side effects (such as nausea or itching) and to help people sleep.
Bisphosphonates are drugs that help protect and prevent the breakdown of bone. They may be used to relieve pain caused by cancer that has spread to the bone.
Muscle relaxants can be used to treat muscle spasms, which can cause pain or make pain worse.
Stimulants and amphetamines may be used to help make opioids work better and reduce drowsiness, which is a common side effect of opioids.
Steroids may help reduce swelling and relieve pain, especially pain from a tumour that presses on or has damaged a nerve. They may also increase appetite and reduce nausea.
Each drug is unique and can cause certain side effects. Side effects can happen with any type of treatment, but not everyone has them or experiences them in the same way. Talk to your doctor, pharmacist or healthcare team to get information about a particular drug.
For more detailed information on specific drugs, go to sources of drug information.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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