Pain

Pain can often be a side effect of a cancer treatment, such as surgery, or the cancer itself. There are many effective treatments for pain control. Often, medications are used in combination with other therapies to provide the best pain relief.

The type of pain medication you’re prescribed depends on the intensity of your pain. Pain is rated on a scale of 0 to 10, with 0 being no pain and 10 as the worst pain imaginable.

Mild to Moderate (1-3) - You may be given an over-the-counter medication, such as Tylenol^® (acetaminophen), or Advil^® or Motrin^® (ibuprofen), which are a class of drugs known as nonsteroidal antiinflammatory drugs, or NSAIDs. There are several other medications in this class that are available. If one does not work or has side effects you cannot tolerate others may still work and be better tolerated.

Moderate to Severe (4-6) - If over-the-counter medication does not relieve your pain, or you have moderate to severe pain, you will be prescribed an opioid. Opioids are the strongest pain-relieving medications available. They include dihydrocodeine, propoxyphene, and Ultram^® (tramadol). Acetaminophen or an NSAID may be added to an opioid.

Severe (7-10) - For severe pain or pain that is not relieved with one of the above-mentioned opioids and/or over-the-counter medications, you may receive a stronger opioid, such as morphine, oxycodone, hydromorphone, methadone, levophanol, or fentanyl. A nonopioid pain medication and/or another drug may be added.

There are many ways to receive pain medication: orally (pill, capsule, liquid); locally (ointment or patch applied to skin); rectally (suppository); intravenously (IV; injection into a vein); subcutaneously (subQ; injection directly under the skin); or intramuscularly (IM; injection directly into the muscle).

Tips

Managing Pain

• If your pain medication instruction is “take as needed,” take it before your pain becomes severe. Pain medications work much better when you “nip it in the bud.” If you wait too long it will take longer to work and not be as effective.
• Always notify your physician if you have pain or it gets worse. There is other medication, or combinations of medication, and doses that may work for you.
• Take your medication as prescribed.
• If your pain relief does not last as long as it should, ask about extended-release medication.
• If your pain is controlled most of the time, but occasionally gets bad enough that your medication does not appear to work, your physician may prescribe a rapid-acting pain medicine. Immediate-release morphine, for instance, can give you additional pain relief quickly, when it is needed.
• Various approaches or activities may help reduce your pain. Ask about exercise, meditation, acupuncture, and massage, among other approaches.
• Report any pain medication side effects right away.
• Keep a pain journal to review with your health care team.
• Do not let the fear of addiction influence your decisions about taking strong pain medicine. Addiction is rarely a problem. Discuss this concern with your health care team.