Cancer and its various treatment options can cause pain. Pain medications are a key part of managing the effects of cancer. Pain relief can include opioids, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and other medications.

Pain is a common symptom of cancer. As a tumor grows, it can destroy neighboring tissue. It can also press on nerves and release chemicals that cause pain.

The treatment options for cancer can also be painful. For example, chemotherapy can cause stinging and peripheral neuropathy pain.

This article examines the medications a person can take to treat cancer-related pain.

A person holding a bottle of medications to treat cancer pain -1Share on Pinterest
Studio Firma/Stocksy

There are several different ways people can receive cancer pain medications. A doctor may administer pain relief in the following ways:

  • Oral: Options include tablets, capsules, and liquid suspensions.
  • Skin patch: Pain relief patches allow the medication to enter the body through the skin.
  • Rectal suppositories: In suppository form, medication dissolves and is absorbed directly into the bloodstream.
  • Injections: Many pain injections are subcutaneous. A doctor injects the medication into the tissue directly below the skin.
  • PCA pump: Patient-controlled analgesia pumps can deliver a constant flow of pain medication or an intermittent flow that the user controls.

Opioids are similar to the natural endorphins that the body produces to relieve pain and stress. They work by activating opioid receptors in the brain.

Opioids make up a significant portion of cancer pain treatment medications.

Doctors prescribe opioids for people experiencing moderate to severe or increasing pain from cancer or cancer treatment. An estimated 40% of people living with cancer experience moderate to severe pain.

Some common opioids for the treatment of cancer pain include:

  • fentanyl (Actiq, Duragesic, and others)
  • hydrocodone
  • hydromorphone (Dilaudid)
  • methadone (Dolophine, Methadose)
  • morphine (Apokyn, Avinza, and others)
  • oxycodone (OxyContin, OxyIR, Roxicodone)
  • oxymorphone (Opana)
  • tapentadol (Nucynta)
  • tramadol (Ultram)

These medications come in extended-release (ER) and immediate-release (IR) versions. ER means the tablet releases the drug slowly, allowing your body to absorb it over time, and IR means the medication is released all at once into your body.

ER opioids can treat chronic pain, and people who take these medications must follow a set schedule.

IR versions have a more rapid onset but only last about 2–4 hours. Doctors prescribe IR opioids to treat breakthrough pain.

Safe use

Doctors consider several factors before prescribing opioids:

  • possible medication interactions
  • a person’s age
  • whether a person is receiving treatment for another medical condition

Doctors may also ask the person receiving the opioids how they store their medications and whether children are in the home.

People taking prescription opioids may choose to have blood or urine tests to monitor their dosage or to help determine the causes of any side effects.

It is unsafe to take opioids with other substances that induce sleepiness, such as alcohol, medication to aid sleep, antihistamines, or antidepressants. Combining opioids with these substances can result in the following:

When a person no longer requires opioid medication, doctors slowly decrease the medication dose. Tapering this way helps to prevent unwanted reactions such as flu-like symptoms, diarrhea, or excessive sweating.

Opioids can result in physical dependency. To safeguard against substance use disorder, doctors may try other pain relief therapies before prescribing opioid medication.

However, the American Cancer Society (ACS) states that some people may need higher doses of opioids. This can be due to worsening pain or because a person has developed a tolerance.

However, requiring an increase in opioid dose does not mean a person has developed an addiction.

Side effects

Some people taking opioid medications for cancer pain experience side effects. These may include:

Some side effects subside after several days of treatment as the body adjusts to the medication.

Non-opioid medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), target mild to moderate pain.

People can purchase them over the counter (OTC) or by prescription. In addition to pain relief, NSAIDs also reduce inflammation.

OTC NSAIDs include:

Prescription NSAIDs include:

  • celecoxib (Celebrex)
  • diclofenac (Voltaren)
  • indomethacin (Indocin)
  • ketorolac
  • meloxicam (Mobic)
  • nabumetone
  • naproxen (Naprosyn)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
  • sulindac

The ACS notes that acetaminophen can reduce a fever. A doctor may not prescribe acetaminophen if a person is undergoing chemotherapy because it can cover up a fever. A fever can indicate an infection.

NSAIDs may also not be suitable for those taking other NSAIDs. Always speak with your doctor or pharmacist before taking multiple pain medications at the same time, as they can work in the same way and cause harmful side effects.

Precautions and considerations

Acetaminophen (Tylenol) may cause liver or kidney damage if a person regularly takes it in large doses or with alcohol, even at the regular dose.

Some medications and other factors increase the risk of complications with NSAIDs:

Teenagers and children should not take products containing aspirin.

People who cannot take acetaminophen or NSAIDs must carefully check the labels of other medications, as they may contain the same ingredients.

Side effects

Side effects can include the following:

Pain relieverSide effects
Acetaminophen Large doses of acetaminophen can cause liver or kidney damage. It can also cause liver damage from lower doses when combined with three or more alcoholic drinks.
NSAIDsNSAIDs can cause:
• drowsiness
• stomach ulcers
• an increased risk of heart failure, stroke, and heart attack

Sometimes cancer pain management involves combining medications, such as:

  • a weak opioid such as tramadol, codeine, or dihydrocodeine and a non-opioid pain medication
  • an NSAID with an opioid such as morphine
  • acetaminophen with an opioid
  • two opioids, such as oxycodone and naloxone

Combinations are not always more effective than using a single medication. A 2017 meta-analysis found that adding gabapentinoids to opioid pain therapy did not significantly improve pain relief for tumor-related cancer.

Other medications to treat cancer-related pain includes:

Drug ClassGeneric NameMechanism of ActionSide Effects
• imipramine
• nortriptyline
• desipramine
• doxepin
They increase spinal and brain neurotransmitters to treat nerve pain.• blurry vision
dry mouth
• drowsiness
• difficulty urinating
• blood pressure changes
• dizziness
• fainting
irregular heart rate
Antihistamineshydroxyzine and diphenhydramineThey help control nausea and itching and promote sleep.• dry mouth and nose
• drowsiness
• mood changes
• difficulty urinating
• restlessness
Anti-anxiety medicationsdiazepam and lorazepamThey reduce anxiety and muscle spasms.• loss of bladder control
• drowsiness
Stimulants and amphetaminescaffeine
They increase opioid pain relief and reduce the sedating effect.• appetite loss
• elevated heart rate
• irritability
Anti-convulsant medicationscarbamazepine, clonazepam, gabapentin, pregabalinThey ease burning and tingling from nerve pain by reducing pain signals from damaged nerves.• liver problems
• low red and white blood cell count
• drowsiness
• dizziness
Steroidsdexamethasone and prednisoneThey reduce bone pain and pain from inflammation.• appetite increase
• fluid buildup
• stomach issues
• increased blood sugar
• trouble sleeping
• confusion
• behavior changes

Both cancer and cancer treatment can cause pain. Cancer pain medications that can provide pain relief include opioids, NSAIDs, and acetaminophen.

Each type of medication has side effects and may interact with other substances. People who use cancer pain medications can get drug safety information specific to them from their doctors or a pharmacist.