While all patients who suffer from cancer will not experience significant or chronic pain, those who do require the administration of a comprehensive medical strategy to manage, control or eliminate discomfort. Fortunately, there exists today a broad spectrum of highly effective analgesic medicines that can bring relief to nearly all individuals who suffer from cancer related pain. Additionally, a cancer patient’s discomfort can be addressed through other medical interventions that can include radiation therapy, chemotherapy, and surgery.

Non-medical/medicinal relief from cancer pain can also be achieved through the use of techniques such as biofeedback, relaxation, imagery and more. By far, however, analgesic medicines are the oncologist’s choice when it comes to pain management in the cancer patient. Outlined below are the broad classes of cancer pain medications, their specific indications (types of pain), and means of administration:

  • Steroids: Many types of cancer pain are caused by tumor masses that press on sensitive nerves, bones or soft tissues. In some instances where visible swelling is present, the prescription steroid drugs dexamethasone or prednisone are taken by mouth.
  • Antidepressants: Some cancer patients report their pain as a burning or tingling sensation, discomfort that can be a result of cell or nerve damage from their disease or a side-effect of one or more cancer treatments. For these patients, antidepressants that are used wholly for their analgesic value may be prescribed. These orally taken drugs include amitriptyline, trazadone, doxepin, and imipramine. Additionally, burning and tingling discomfort can be treated with the antiepileptic drug gabapentin.
  • Non-opioids: While cancer can cause some patients extreme discomfort, for those individual’s whose pain is mild or moderate, physicians will generally rely on analgesics such as acetaminophen or a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). The most popular and widely known NSAIDs include aspirin and ibuprofen, the latter available in over-the-counter form as well as in prescription strength. Non-opioids are generally taken by mouth.
  • Opioids: For those cancer patients who experience moderate to severe pain, a powerful class of opiate derivative drugs are prescribed. Opioids are generally taken by mouth, though, intravenous administrations can also be used. Some of the more commonly utilized opioids are morphine, oxycodone, codeine, hydrocodone, methadone, fentanyl, and others.

Alternative Methods of Analgesic Administration

While most cancer patients are able to take their pain medications orally, either in pill or liquid form, other individuals who have trouble swallowing or another condition that prevents oral administration, the following, alternative drug delivery methods may be employed:

  • Intravenous: This form of pain medication delivery is oftentimes referred to as Patient Controlled Analgesia (PCA). In PCA, pain medications are delivered through an intravenous line supplied needle that remains lodged in a patient’s vein. Patients who suffer from chronic or severe pain may increase their analgesic dosage by pressing a button until an effective level of pain relief has been achieved.
  • Suppositories: Some cancer patients can elect to have their pain medication delivered through rectal suppositories that gradually dispense medication over time.
  • Patches: Medicine filled patches are placed on the skin and release analgesics in prescribed doses over time.
  • Injection: Many types of analgesics can be administered through a variety of needle injections such as: subcutaneous (medicines are lodged just below the surface of the skin); intravenous (medicines delivered directly into a vein); epidural or intrathecal ( medicines delivered through a tube directly into the small of the back).
  • Intramuscular injections: This is one of the least favored methods for the delivery of long-term cancer pain management. Intramuscular injections require a needle penetration deep into muscle tissue, a procedure that can be quite painful, and as a result, these types of injections are only used in rare and highly specialized situations.

 

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