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How these medications work

Many treatments for nociceptive pain work by binding to pain receptors so that pain messages are not sent to the brain. Other treatments given with pain medications can reduce swelling and inflammation, which, in turn, reduce pain. An entirely different group of drugs can help pain medications work more effectively, so your oncologist may recommend more than one drug for treating pain.

The best defense is a good offense

Many drugs are effective in treating nociceptive pain caused by cancer. They can help you feel better and improve your functioning and quality of life. The key is to work with your oncology nurse and physician-and don't be shy about mentioning any new symptoms.

Most Helpful

Many different types of drugs can accomplish this in various ways.

  • Acetaminophen can reduce pain and fever (if fever is present).
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids reduce swelling and inflammation and also have pain-relieving properties.
  • Opioids bind to pain receptor sites to reduce pain. Many forms of opioids exist: Some are short-acting; others are long-acting. Some are synthetically made. The type of opioid used depends on your symptoms, previous pain medications tried, and other variables. The most common opioid is morphine.
  • Local anesthetics can numb pain directly.
Likely to Be Helpful

Two treatments fall into this category. Both help reduce pain caused by cancer that has spread to the bones.

  • Bisphosphonates inhibit the activity of cells that cause cancer-ridden bones to break down abnormally.
  • Injections of radioactive medicine act only on cancer cells, sparing healthy tissue. A radioactive medicine consists of two parts: a "targeting molecule," which is attracted to cancer sites, and a radioactive tracer, which delivers low-dose radiation to the targeted cancer cells.
May or May Not Be Helpful

Spinal opioids are delivered via injection or infusion into the spinal column. Because this type of delivery method bypasses the digestive system, you don't get the sedative effects as you normally would with opioid medications. However, this delivery method usually involves a surgical procedure to insert a needle, like a spinal tap, into the spinal column. This option is used when other medications fail to provide adequate pain relief.

Caffeine works with your pain medication to improve its pain relief.

The ONS Web site lists clinical studies conducted on these topics.

Not Enough Evidence

Many treatments fall in this category.

  • Certain antihistamines can relieve itching and inflammation and have some pain-relieving properties.
  • Dextroamphetamine counteracts the sedating effects of opioid medications.
  • Ketamine is a pain reliever that can be given via IV or under the tongue.
  • Skeletal muscle relaxants treat muscle spasms.
  • Topical agents are creams or lotions with drugs in them that can be applied to the skin. Many different kinds of drugs, including pain relievers, can be compounded to make a topical agent.
  • Tetrodotoxin has pain-relieving properties. It comes from pufferfish.
Not Recommended

Carbamazepine, a type of anticonvulsant, is not recommended for use in older patients and others because it has significant side effects.

Codeine and its derivatives have not been effective in treating nociceptive pain. Other opioid pain relievers that have no positive effect on nociceptive pain include meperidine and mixed agonists-antagonists.

Propoxyphene is a nonopioid pain killer that is not effective for treating this type of pain.

Phenothiazines, a class of drugs known as antipsychotics, do not help with nociceptive pain.

 

Nonsteroidal anti-inflammatory drugs

non-narcotic drugs that can reduce pain, fever, and inflammation

 
 

Corticosteroids

synthetic versions of hormones that are used to treat inflammation

 
 

Opioids

natural or synthetic opium derivatives; opioids are a type of pain killer that works on the central nervous system

 
 

Compounded

a way of preparing drugs manually, according to individualized need. Compounding may be done if a person is sensitive to dyes in medicines, if oral administration is a problem (such as with children), and for other reasons. Virtually any medication in its pure form can be compounded. A “carrier” (in this case, a cream or lotion) is mixed with the medication(s) to create the topical agent.

 
 

Antipsychotics

drugs used to treat certain kinds of mental health disorders, such as schizophrenia. Small doses of some antipsychotics may be used to relieve pain.