Controlling cancer pain is a key component of the overall treatment plan. The most successful plan uses multiple therapies to prevent pain from surfacing. When the pain does break through, the proper dose of pain reliever should be taken immediately. Many patients have a tendency to wait until the pain is bad before taking something. Chasing the pain often results in more pills and less effective pain control.
Which is the best pain treatment depends on the level of pain and the cause of pain. Mild pain often can be treated with acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen and naproxen are two NSAIDs frequently suggested for mild cancer pain.
Moderate to severe pain usually requires an opioid. Hydrocodone or oxycodone may be tried first. If neither is adequate, there are stronger pain relievers, such hydromorphone (Dilaudid) and short-acting morphine. Long-acting narcotics like methadone and sustained-release morphine sulfate are used when breakthrough pain is a problem. For patients that have a hard time swallowing pills, options include liquid morphine and a fentanyl skin patch.
Adjuvant medications are drugs that help analgesics work more effectively. They include:
- Tricyclic compounds, like amitriptyline and doxepin, that can improve the action of opioids. They are especially helpful in relieving nerve pain.
- Benzodiazepines, like lorazepam and diazepam, that control anxiety to help reduce dosage of pain pills.
- SSRIs (selective serotonin reuptake inhibitors) and other antidepressants, that improve mood.
- Nerve-pain modulators, like gabapentin, that control pain by mechanisms independent of opioid brain receptors.
Other important therapies to control pain include breathing exercises, relaxation techniques, cutaneous stimulation with cold and heat, massage and acupuncture.