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Your questions about cancer-related pain, answered
We spoke with an expert who specializes in oncology. Here are his best insights on how to cope with cancer pain.
It’s extremely common for people with cancer to experience some form of pain.
That pain can come from many things. First, the cancer itself can be painful. Tumors can press on nerves, bones and organs. Second, cancer treatments and surgeries can often be a source of discomfort, says the American Cancer Society. Chemotherapy and radiation may come with a whole host of painful side effects. These can include nerve damage, mouth sores and injuries such as burns and scars.
Many people just assume they have to deal with pain while undergoing cancer treatment. But it’s important to know that there are many options to help control your discomfort. It’s never too early to ask your doctor about pain management. Even if the pain can’t be completely eliminated, there is always a way to manage it and reduce it to a level that you’re able to live with.
If you have cancer-related pain, talk with your doctor regularly about how you feel and how your medications are working. This way he or she can continue to make adjustments as needed. (If high prescription costs come between you and pain relief, we can help. Bring your free discount card to the pharmacy to see how much you could save.)
To learn more about what medications can help reduce cancer-related pain, we talked to Hamed I. Ali, PhD. He’s an assistant professor in the department of pharmaceutical sciences at Texas A&M University.
Q: Which over-the-counter (OTC) medications are used to treat mild pain related to cancer and cancer treatment?
Ali: Low and mild cancer pain can be treated using low-strength OTC pain relievers. These are also called analgesics. There are 2 types: The first is non-steroidal anti-inflammatory drugs (NSAIDs). These medications work by minimizing or controlling pain and inflammation. Examples include aspirin, ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).
The other type of OTC pain reliever is acetaminophen, which does not reduce inflammation. Some common brand names are Tylenol® and Panadol®.
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Q: When might someone need a prescription NSAID or analgesic?
Ali: When those low-strength OTC products aren’t cutting it, such as in moderate to severe cancer pain, people usually need a more potent dose. And those are only available by prescription. That’s because there are a lot of potential side effects, especially with NSAIDs. The most concerning are stomach ulcers and bleeding. If your doctor prescribes these, they will keep a close eye on you.
Q: What other side effects do people need to be aware of?
Ali: You and your doctor should seriously consider the side effects of higher doses of NSAIDs. They may help control the pain, but their side effects can affect the patient dramatically, sometimes significantly more than the cancer itself.
Some cancer patients may also have high blood pressure, so they can’t use these medications for a long duration. It’s recommended that those with kidney disease avoid using NSAIDs as well.
Q: What can be done for pain that analgesics can’t control?
Ali: Opioids can be used for moderate to severe pain. This type of medication blocks specific pain receptors in the brain. And they can be very effective for pain management.
When the pain is less severe, they are often paired with an analgesic. For example, codeine and acetaminophen can be taken together. This type of combination works synergistically, controlling the pain from multiple angles. A bonus is that they have fewer side effects than taking a higher dose of one of them.
Q: What are the side effects of opioids?
Ali: There can be many. Constipation, confusion, dry mouth and fatigue are common ones. We can manage constipation with more fiber-filled meals and using some laxatives.
We also have to consider physical dependence and the risk of developing opioid-use disorder. Therefore, it’s best to start with a low dose because a higher dose makes it easy to build physical dependence faster. Combining opioids with an analgesic can also help minimize the dosage of the narcotic that’s needed for effective pain relief.
We always want to minimize use of opioids to avoid physical dependence or opioid use disorder. Talk with your health care team about how to control your pain with as few side effects as possible.
This may include trying different types of opioids, such as transdermal patches. They have an adhesive that goes on your skin and steadily releases the medication. An example is fentanyl (Duragesic®). These patches can help you and your doctor control your dose, and they may even reduce misuse. Another benefit is that they are less likely to cause constipation.
Q: Is there anything else people should know about using opioids for cancer pain?
Ali: Never mix opioids with alcohol. You have to stop drinking if you’re going to take opioids. Opioids cause drowsiness and sedation and slow down the breathing rate. This side effect of breathing depression through the central nervous system can be fatal.
Q: What is a nerve block, and when can it be helpful for cancer pain?
Ali: A nerve block is a local anesthetic. It’s injected around a nerve and sometimes into the spinal cord to block the pain signal from traveling up from the nerve to the brain.
Some doctors recommend nerve blocks when cancer is in an advanced stage or when all of these other pain management options still can’t cut it. This pain control remedy is commonly given to pancreatic cancer patients.
Nerve blocks are frequently combined with steroids, which reduce inflammation around the nerves. The frequency of injections depends on pain levels and side effects. If the side effects are severe, we have to minimize the frequency.
Q: What are the potential side effects of a nerve block?
Ali: Well, sometimes the injection itself is very painful. And it can lead to soreness and bleeding at the site of injection. If you’re allergic to the medication, it can cause a severe rash and itching.
It’s not common, but the nerve itself can become temporarily or permanently paralyzed at the site of the injection. A nerve block can also really irritate the nerve and end up causing more pain and discomfort than the original cancer-related pain. When steroids are combined with the nerve block, the most common side effect is weight gain.
Q: Are there any other medications that can help with cancer pain management?
Ali: We have a lot of narcotic use disorder in the U.S. So oncologists try to avoid opioids if other less risky medications can effectively control a person’s pain.
Anti-seizure medications are another type of drug they may prescribe, including levetiracetam (Keppra®), which is specifically used in brain cancer patients. These medications were originally discovered to help people with epilepsy. But they also have a nerve-calming ability, and they can reduce the amount of pain signals to the brain.
Anti-seizure medications can also be used to reduce (or replace) the amount of opioids a person needs.
Some antidepressants such as venlafaxine (Effexor®) and duloxetine (Cymbalta®) can also help control cancer-related pain when accompanied by depression. They are generally safer with fewer side effects. Keep in mind that they don’t work immediately. Maximum benefit can take several weeks. But people generally find moderate pain relief — in addition to other mood-boosting benefits.
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Facts about cancer pain: American Cancer Society