Pain Management

There are many causes of cancer pain, but often cancer pain occurs when a tumor presses on nerves or body organs or when cancer cells invade bones or body organs. Cancer treatments such as chemotherapy, radiation, or surgery also may cause pain.

Mild to Moderate Pain

Pain relievers: Acetaminophen  and a group of pain relievers called nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen  can treat mild to moderate pain. Many of these are over-the-counter drugs that do not require a prescription, but some do require a prescription. Patients should check with a doctor before using these medicines, especially if they are getting chemotherapy. NSAIDs can interfere with blood clotting, cause gastrointestinal and kidney problems, and may lead to increased risk of heart attack or stroke.

Moderate to Severe Pain

Narcotic pain relievers: These drugs include codeine, morphine  hydrocodone , hydromorphone  , fentanyl , oxycodone , and tramadol. Narcotic pain relievers require a prescription and may be used along with mild pain relievers for moderate to severe pain.

Tingling and Burning Pain

• Antidepressants: Certain antidepressants are used to relieve pain even if the person isn’t depressed. Amitriptyline and nortriptyline , and duloxetine 
  are antidepressants sometimes used to treat pain.
• Anticonvulsants (anti-seizure medications): Despite the name, anticonvulsants like gabapentin and carbamazepine are used not only for seizures, but also to control burning and tingling pain, painful symptoms of nerve damage.
• Other drugs: Corticosteroids such as prednisone are used to lessen swelling, which often causes pain.

 The first step in managing pain is to do a total pain assessment. You may be asked to choose a number from 0 to 10 to rank your pain, with 0 being very mild pain and 10 being the worst possible pain you could have.

Most pain problems can be controlled by using the World Health Organization’s step-care approach: 

• Step 1. Start with a nonsteroidal anti-inflammatory drug (NSAID). Examples of NSAIDs include over-the-counter drugs like ibuprofen and stronger NSAIDs that your healthcare provider may prescribe. An alternative to NSAIDs for step 1 pain is acetaminophen.
• Step 2. If pain continues or gets worse, your healthcare provider may prescribe a weak opioid medicine, like hydrocodone. A weak opioid may be combined with a nonopioid pain reliever.
• Step 3. If pain continues or gets worse, your healthcare provider may prescribe a stronger opiate. Examples of strong opioids include morphine and fentanyl.

Opioid drugs are the most effective and commonly used drugs for moderate to severe pain. A wide range of opioid drugs is available, and they can be taken in a variety of ways. One drawback of these medicines is that, over time, you will almost certainly develop a tolerance to the one you’re taking and need higher doses to get the same effect. One way your healthcare provider may get around this problem is by switching the type, dose, or the way the drug is given.

These are common ways in which opioid drugs can be given:

• Oral medicines. These can be taken in pill or liquid form and can be short acting or long acting (sustained release).
• Adhesive patch. This can be applied to the skin to release medicine over time. An example of this is a fentanyl patch.
• Opioid drug injection. This shot may be given under the skin or into a muscle.
• Opioid drug IV. An opiate may be given directly into the blood through an intravenous line.
• Medicine pump. Opiate medicine can be given through a pump attached to an IV line that you control. This is called patient-controlled analgesia.
• Spinal injection. For pain that’s hard to control, a pain-control specialist may give an opioid drug directly into the spinal cord area.