Managing Side Effects | Treatments for Pain

Pain can be managed effectively in a number of ways, depending on the cause and type of your pain. Treatments may include:

Medications - nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opioid analgesics, antidepressants, antiepileptics, steroids
Psychosocial interventions - stress management, counseling, coping mechanisms
Rehabilitation techniques - physical therapy, exercise therapy, heat/cold therapy
Complementary therapy - meditation, hypnosis, biofeedback, guided imagery, music therapy, massage, acupressure, acupuncture, reflexology, therapeutic touch, Reiki, yoga, tai chi, qigong (chi gong), herbs and vitamins

Medications to Treat Pain

Almost all people find relief from pain by using a combination of medicines. Most pain medicines are pills that are swallowed or dissolve quickly in the mouth. Some also come in liquid form. If you’re unable to take medicine by mouth, pain medicines can also be given intravenously, rectally (as a suppository), as a shot, or as a cream or patch. Your healthcare team will consult with you and together you’ll decide which medicine you need, how to take it, how much you need (the dose), and how often you should take it.

Acetaminophen and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter (OTC) medicines like acetaminophen (Tylenol®) and NSAIDs (aspirin, Advil® and Aleve®) can work very well for treating mild to moderate pain. These drugs are good pain relievers, but they can be harmful if you take more than the recommended amount. If you’re taking acetaminophen or an NSAID, be sure to follow the package instructions carefully. Some people should not take acetaminophen or NSAIDs, so talk to your healthcare team before using these medicines. Even drugs you can buy without a prescription can be dangerous if not taken correctly.
Opioids: These are medicines that can work very well to treat moderate to severe pain. You need a written prescription to get these drugs. Be sure to follow your doctor's directions very carefully. There are many types of opioids. Morphine is the opioid that’s most often used to manage cancer pain. Others that are commonly used include: hydromorphone (Dilaudid® or Exalgo®), oxycodone, hydrocodone (Hysingla® or Zohydro ER®) , codeine, fentanyl and methadone.
- Some opioids are combined with acetaminophen or an NSAID in one pill. Example include Percocet® (a combination of oxycodone and acetaminophen), Vicodin® or Norco® (a combination of hydrocodone and acetaminophen) and Vicoprofen® (a combination of hydrocodone and ibuprofen).
Antidepressants and Antiepileptics: Antidepressants are medicines most often used to treat depression. Antiepileptics are medicines used to help prevent seizures. Both antidepressants and antiepileptics can also be used to manage pain in people with cancer. They are very good for treating nerve or neuropathy-related pain. Taking these medications to help manage cancer pain does not mean that you are depressed or that you are going to have seizures.
Steroids: These are a type of medicine that can relieve pain caused by swelling or inflammation. Prednisone and dexamethasone are often used to manage pain in people with cancer.

Many times a combination of medicines is needed to control pain. Your doctor will work with you to find the right combination of treatments to control your pain.

Addiction Risk

Some people worry about the risk of addiction when using opioids for pain control. People with chronic pain who need prolonged opioid therapy and take these medicines as directed have little-to-no risk of becoming addicted to these drugs. Make sure you understand the instructions for taking your medicine (such as proper dosage and timing) and take only the amount that is prescribed.

Still, there are people who might be at risk for addiction. These people tend to have a current or past history of substance misuse, a family history of addictive disease (alcohol, illegal drugs or prescription drugs) or a history of mental illness. Talk with your healthcare team about whether you’re at risk for developing an addictive disease. This does not mean that you can’t use opioids to treat your pain, but you may need an additional support and monitoring.

Managing Your Pain Medicines

Remember to tell your healthcare provider and other members of your treatment team about all of the medicines you are taking, including over-the-counter drugs, supplements and herbal remedies. Also tell them if you are using alcohol, marijuana or CBD, or illegal drugs in any form. Sometimes there can be serious interactions. Your healthcare team can provide helpful guidance.

If you’re using medicines to manage your pain, it’s your responsibility to keep all your drugs in a safe place. It’s best if they’re locked up. These drugs should not be within the reach of children, friends, pets or visitors. They could be stolen if left out in the open. They can be dangerous if taken incorrectly

Side Effects of Pain Medication

Many pain medicines have side effects. Talk with your healthcare provider right away about any side effects you notice. There are often things you can do to treat and even help prevent them. Side effects can include:

Some other side effects of opioids to watch for include itchiness, dry mouth, sneezing, sweating, feeling irritable, dizziness, confusion, memory changes, vision changes and trouble passing urine.

Your healthcare provider will talk with you about the side effects linked to your pain management plan. Be sure you know what to expect, what to do to help with side effects, and when to call your provider.

Other Options to Control Pain

Some other options doctors provide that can help control pain include:

Nerve blocks—injections of anesthetic into the affected area
Nerve ablation—destruction or removal of nerve tissue
Epidural injections—medicine is injected into an area of the spinal cord
Implanted devices, such as:
- Intrathecal pump—a device that delivers pain medication directly into the spinal fluid
- Spinal cord stimulation—a device that sends mild electrical currents to the spine
Surgical procedures, such as:
- Vertebroplasty—chemical cement is inserted into damaged bone or vertebra through a catheter to add strength and improve stability
- Kyphoplasty—a balloon is inserted and then inflated in the vertebra to get it into its normal position before stabilizing the area with chemical cement

Peripheral Neuropathy

For more information, see Peripheral Neuropathy.

Non-Drug Treatments for Pain

While medicines are most commonly used to manage pain, many people with cancer also use non-drug and integrative therapies to find relief. These therapies, especially when used along with pain medicines, can result in better pain relief with fewer side effects. Mind-body practices can help relieve anxiety, sleep disturbances and mood changers commonly associate with pain.

For more information, access the free LLS fact sheet, I ntegrative Medicine and Complementary Therapies.

It's important for you and your doctor to discuss the type(s) of nondrug approaches that may be most appropriate for your condition. Tell your doctor if you're using any complementary or alternative treatments, as some natural products can change the way your body reacts to prescribed medications.

Pain Treatment

Treatment