Cancer Pain – Part 2: Medical Treatment

Medicines that are used to relieve pain are called analgesics. Analgesic drug therapy is the main pain relief method used for most cancer patients. 70-90% of a cancer patient’s pain can be controlled using a combination of nonopioid, opioid, and adjuvant drugs.

1.    Nonopioid Analgesics. For mild pain, people can buy over-the-counter, nonprescriptive analgesics, such as aspirin, acetaminophen (e.g., Tylenol®), or ibuprofen (e.g., Advil®), naproxen. Aspirin and ibuprofen are two of many non-steroidal anti-inflammatory drugs (NSAIDs). Due to potentially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

2.    Antidepressants: These are not taken to relieve depression, but because they may help relieve nerve pain that sometimes develops from cancer treatment.  Some commonly-prescribed antidepressants in this category include Elavil®, Pamelor® and Norpramin®.

3.    Anticonvulsants: These drugs, originally developed to help manage seizures, are helpful in relieving cancer-related neuropathic (nerve) pain. Some anticonvulsant medications used for cancer pain management include Neurontin®, Tegretol® and Klonopin®, among others. Side effects can include lowered blood counts, dizziness, blurred vision, and nausea.

4.  Corticosteroids: Corticosteroid medications, such as dexamethasone and prednisone, work effectively to reduce inflammation, thereby helping to ease some forms of cancer pain. Short-term used of these medications may cause increased appetite and fluid retention. Long-term use can result in weight gain, “moon face,” osteoporosis, and other side effects.

5.  Bisphosphonates:These medications help relieve the pain of cancer that has spread to the bones. Bisphosphonates like Aredia® and Clodronate® are most commonly used for this purpose.

6.    Radiation: which is also used to treat cancer, can be very helpful in alleviating cancer pain in some circumstances.  It can be used to reduce the size of some tumors which, in turn, takes pressure off organs and nerves that the tumor touches.  It can also be used to treat the pain of cancer that has spread to the bones, the brain, blood vessels, nerves and spine.

7.    Chemotherapy: which you know is used primarily to treat cancer, can also sometimes be helpful in reducing the size of or stabilizing tumors and thereby easing pain, even if a cure may not be possible.

8.    Opioid Analgesics: Morphine is the prototype opioid analgesic, though opioids vary in effectiveness and side effects. They are often prescribed for severe cancer pain. The medication can lead to dependence, addiction and tolerance. Tolerance is the need for increasing amounts of opioids to achieve the same pain relief. Common side effects of opioid usage include gastrointestinal disturbance (constipation, nausea, and vomiting) and central nervous system disorders (delirium, sedation, confusion, respiratory depression, urinary retention, sudden muscle cramping).

9.    Anesthetic and neurosurgical pain management. Anesthetics are substances that block nerves so that they can no longer transmit pain signals. The neurosurgical control of pain is the use of surgery to remove the tumor in the nervous system that is causing the pain (antitumor neurosurgery) or block pain pathways (antinociceptive neurosurgery).

Common Pain Medicines — Opioids

Trade Name
Generic Name
Oxycontin® (sustained release)
Percocet®
Roxicodone®
Roxicet®
Tylox®
Oxycodone
Oxycodone + acetaminophen
Dilaudid® Hydromorphone
MS Contin®
Kadian®
Avinza®
Oramorph® (sustained release)
MSIR®
Roxanol® (immediate release)
Morphine
Duragesic® (sustained release)
Actiq® (immediate release)
Fentanyl
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