Pain Management - Pain Medications & Side Effects

Pain Medication

Medication is one of the most common methods of treating cancer pain. Doctors may use various combinations and doses of medicine. Ask your health care provider to tell you more about the medicine you are taking, and don't take any new medicine without first checking with your doctor or nurse. Even aspirin can be a problem for some people who are taking other medicines or having cancer treatment.

Side Effects of Pain Medication

All medicines can have some side effects, but not all people get them. Some people have different side effects than others. Most side effects happen in the first few hours of treatment and gradually go away. Each one is an anticipated side effect, and most can be treated so that the pain can be effectively managed. If the side effects cannot be alleviated, doctors may switch a patient's pain medication to make sure a patient gets the maximum pain control with minimum side effects. The benefits and risks of various categories of pain medicine are outlined in the next section.

Cancer pain is most commonly treated with opioid medication. Some of the most common side effects of opioid medication are:

Constipation:(not being able to have a bowel movement): The best way to prevent constipation is to drink lots of water, juice and other liquids, and to eat more fruits and vegetables. Exercise also helps to prevent constipation. Your doctor or nurse may also give you a stool softener or a laxative.

Nausea and vomiting:When this happens, it usually only lasts for the first day or two after starting a medicine. Tell your doctors and nurses about any nausea or vomiting. They can give you medicine to stop these side effects.

Sleepiness:When first starting to take opioids, some patients feel drowsy or sleepy. For most patients, this side effect usually disappears within one to three days. Talk to your doctor or nurse if this is a problem for you.

Slowed breathing:This sometimes happens when the amount of medicine you are taking is increased. Your doctor or nurse can tell you what to watch for and when to report slowed breathing.

More serious side effects of pain medicines are rare. As with the more common side effects, they usually happen in the first few hours of treatment. More serious side effects include trouble breathing, dizziness and rashes. If you have any of these side effects, you should call your doctor or nurse right away.

Benefits and Risks of Treatment

The list below describes the benefits and risks of the different types of medicines used to relieve cancer pain.

Nonopioids -Examples: Acetaminophen, aspirin, ibuprofen
Benefits:These drugs control mild to moderate pain. Some can be bought over-the-counter (without a prescription).
Risks:Some of these medicines can cause stomach upset. They also can cause bleeding in the stomach, slow blood clotting and kidney problems. Acetaminophen does not cause these side effects, but high doses of it can hurt the liver. Drugs that include salicylates, ibuprofen and acetaminophen may affect blood platelets. Cancer patients should check with their physician before using these over-the-counter medicines.

Opioids -Examples: Morphine, hydromorphone, hydrocodone, oxycodone, codeine, fentanyl, methadone
Benefits:Control moderate to severe pain and do not cause bleeding.
Risks:May cause constipation, sleepiness, nausea and vomiting. Opioids sometime cause problems with urination or itching. They may also slow breathing, especially when they are first given, but this is unusual in people who take opioids on a regular basis for pain.

Antidepressants -Examples: Amitriptyline, imipramine, doxepin, trazodone
Benefits:Help control tingling or burning pain from damaged nerves. They also improve sleep.
Risks:May cause dry mouth, sleepiness and constipation. Some cause dizziness and lightheadedness when a person stands up suddenly.

Antiepileptics -Example: Gabapentin
Benefits:Antiepileptics help control tingling or burning from nerve injury.
Risks:They may hurt the liver and lower the number of red and white cells in the blood. It is important to have regular blood tests to check for these effects.

Steroids -Examples: Prednisone, dexamethasone
Benefits:Steroids (also known as corticosteroids) help relieve bone pain, pain caused by spinal cord and brain tumors, and pain caused by inflammation. Steroids also increase appetite.
Risks:They may cause fluid to build up in the body. May also cause bleeding, irritation to the stomach, increased blood sugar, muscle weakness and thrush. Confusion is a problem for some patients when they take steroids.