Pain Relief Pharmacy

How is Cancer Pain Treated?

Cancer pain is very treatable. Approximately nine out of 10 cancer pain patients will find relief using a combination of medications. Although cancer pain is usually treated with medicine, other treatments such as radiation therapy, surgery, relaxation, biofeedback, imagery and other non-drug treatments can be used with medicine to give even more pain relief.

The following page lists the general types of pain medicine and the methods by which they are taken. Ask your doctor, nurse or pharmacist for advice before you take any medicine for pain.

Types of Pain Medicine

Many medicines are used to treat cancer pain, and your doctor may give you one or more to take. The following list describes the broad groups of pain medicine and the kind of pain each works on. Information on specific pain medications and their side effects is located elsewhere on this website.

For mild to moderate pain
Nonopioids:Examples are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. You can buy many of these over-the-counter (without a prescription). Others need a prescription.

For moderate to severe pain
Opioids:Examples are morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl and methadone. A prescription is needed for these medicines. Nonopioids may also be used along with opioids for moderate to severe pain.

For tingling and burning pain
Antidepressants:Examples are amitriptyline, imipramine, doxepin and trazodone. A prescription is needed for these medicines. Taking an antidepressant does not mean that you are depressed or have a mental illness.
Antiepileptics:Examples are gabapentin and other medications. A prescription is needed for these medicines. Taking an antiepileptic does not mean that you are going to have seizures.

For pain caused by swelling
Steroids:Examples are prednisone and dexamethasone. A prescription is needed for these medicines.

How Pain Medicine is Taken

Most pain medicine is taken by mouth (orally). Oral medicines are easy to take and usually cost less than other kinds of medicine. Most oral medicines are in tablet (pill) form, but sometimes they are liquids that you drink. If it is hard for you to swallow and you cannot take a tablet or liquid for some other reason, there are other ways to get these medicines. These include:

Rectal suppositories
Medicine that dissolves in the rectum and is absorbed by the body.

Transdermal patches
Patches that are filled with medicine and placed on the skin.

Many kinds of injections can give pain relief. Most injections use a tube or needle to place medicine directly into the body. Types of injection include:

Subcutaneous- medicine is placed just under the skin using a small needle.
Intravenous- medicine is placed directly into a vein through a needle that stays in the vein. This method includes a type of pain managment called patient-controlled analgesia (PCA). PCA lets patients adjust how much medicine they receive according to their level of pain.
Epidural or intrathecal- medicine is placed directly into the back using a small tube. Most of these injections give pain relief that lasts for many hours.
Subdermal and intramuscular- commonly known as “shots,” these injections are placed more deeply into the skin or muscle using a needle. These injections are not recommended for long-term cancer pain treatment. Constantly having shots into the skin and muscle can be painful.

Can cancer pain be controlled?

Cancer pain can be controlled in almost every case. This does not mean that you have no pain, but that it stays at a level that you can bear.

Cancer and its treatments can be painful. A tumor that presses on bones, nerves, or organs can cause pain. Surgery for cancer can cause pain. So can chemotherapy and radiation. There are a number of ways to control each of these kinds of pain.

You are the only person who can say how much pain you have, or if a certain pain medicine is working for you. Telling your doctor exactly how you feel is one of the most important parts of controlling pain.

What does your doctor need to know?

The more specific you can be about your pain, the more your doctor will be able to treat it. It often helps to write everything down. Include:

• When your pain started, what it feels like, and how long it has lasted.
• Any changes in your pain.
• If the pain is constant or if it comes and goes.
• If you have more than one kind of pain. Use words such as dull, aching, sharp, shooting, or burning.
• What makes your pain better or worse.
• A rating of your pain on a scale of 0 to 10, with 10 being the worst pain you can imagine.

Tell your doctor exactly where you feel pain. You can use a drawing. Say if the pain is just in one place, if it is in several places at once, or if it moves from one place to another.

How is cancer pain managed?

Pain control often starts with medicine. Many drugs are used to treat pain. You and your doctor may need to adjust your medicine as your pain changes. Your doctor may suggest different drugs, combinations of drugs, or higher doses.

For a tumor that causes pain, removing or destroying all or part of the tumor, if possible, often helps. Doctors use chemotherapy, radiation, or surgery to do this.

There are many other ways to control cancer pain, including:

• Heat or cold.
• Splints or braces.
• Massage.
• Treatments that help you cope better with the pain, such as relaxation exercises, biofeedback, or guided imagery.
• Drugs you can buy without a prescription, such as ibuprofen, aspirin, or acetaminophen.
• Stronger drugs your doctor can prescribe. These include:
  • Drugs that relieve pain and swelling.
  • Mouthwashes that help with mouth sores.
  • Very strong painkillers.
  • Drugs used to treat depression. These drugs can relieve pain and help you sleep.
  • Some of the drugs used to treat seizures. These drugs help control burning and tingling pain caused by nerve damage.
  • Skin creams that help relieve pain.

Nerve blocks may help with very bad pain. Drugs are injected right into the nerve that affects the painful area. They provide short-term pain relief by preventing the nerve from sending pain signals.

Learning as much as you can about your pain may help. Emotional support from your friends and family may also help. Many people use other kinds of treatment, such as acupuncture and aromatherapy.

What is a pain control diary?

This is a record of your pain treatment and how it helped or did not help you. You can write down when you used each treatment, how it worked, and any side effects it caused. Having it written down helps you let your health care team know exactly how well your treatment is working.

Will you get addicted to pain medicine?

Some pain medicines can cause your body to keep expecting the medicine if it is used for longer than a week or so. This is called a drug dependency. Dependency is not the same as addiction. Addiction is a behavioral disorder in which a person has a craving for the drug. This craving may not even be related to the level of pain.

Many people who take pain medicine worry about getting addicted. Addiction to pain medicine is rare if you have not had a problem with addiction in the past and you take your medicine as directed under your doctor’s care.

Do not let your fear about becoming addicted get in the way of pain relief. Ask for pain relief if you need it. Pain is easier to control when you treat it as soon as it starts. You may also be able to predict pain and treat it before it begins, such as before physical activity. Pain is harder to control if you wait until it is bad.

When drugs are not enough to relieve cancer pain or when they cause troublesome side effects, treatments such as radiation and nerve blocks may help.

• Radiation is the use of X-rays to destroy cancer cells and shrink tumors. It is used to destroy cancer growths that press on your nerves, bones, or spinal cord. The type of radiation that you receive depends on your cancer diagnosis, the area of your body that is affected, and your previous history of radiation therapy. Destroying growths relieves pressure on organs and nerves and reduces pain.
• A pump that is placed under your skin may be used to deliver pain medicine directly to your spine. Because the drug goes right to your spinal column, not as much of it is needed. That usually means that side effects are not as severe.
• Nerve blocks usually are used only after other treatments have not worked. A nerve block is a drug that is injected into or around a nerve to temporarily prevent the nerve from telling your brain about the pain. In some cases, deadening the nerve may not only reduce the pain but also lower the amount of medicine you need.

What to think about

Radiation treatments may cause side effects, such as diarrhea and fatigue. The type of side effects that may develop depend on your cancer diagnosis, the area of your body that is affected, and the type of radiation that you have. You can use home treatment measures for diarrhea and fatigue to help you manage these side effects.

Nerve blocks can cause loss of feeling or, in rare cases, paralysis in the affected area or in the tissue surrounding the area.

Surgery is sometimes used to relieve cancer pain. Removing a tumor that is pressing on nerves, bones, or your spinal cord can help your pain. Surgery can also remove tumors that block the intestine and cause pain. The type of surgery that you may have depends on the type of cancer you have, which parts of your body are affected, and what treatments you have had before.

What to think about

Although surgery to control pain does not cure cancer, it can help you feel more comfortable. Talk to your doctor about the benefits and risks of surgery.