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Beyond Chemotherapy – Drugs Used to Control Pain

Some pain is associated with surgery and radiation during the treatment of breast cancer. Pain may also be caused by cancer that has metastasized to the bone or other locations in the body. There are various drugs and medications available to help manage these pains.

The Goal of Pain Medicine

  1. To decrease the intensity of pain to levels that are tolerable
  2. To reduce the frequency of which you experience pain

To accomplish this, the medications used must be fast-acting and effective. With what is termed “breakthrough pain”, or pain that occurs between doses of pain medicine, drugs must also be fast-acting but have a shorter duration of activity. This will help to decrease the risk of opioid toxicity since the drug should wear off before the next regular treatment of pain medication.

Severity of Pain

Every person has a different pain tolerance. Some prefer not to use any pain medication at all and are able to tolerate pain, while others cannot bear even the smallest amount of pain. It is important to understand how well you tolerate pain, how to recognize pain and how pain affects healing[1]. Your medical professional can provide you with tests that will help determine how severe your pain is and what type of pain you are experiencing. These are basic severity levels of pain:

  • Mild
  • Mild to moderate
  • Moderate to severe
  • Severe or excruciating

Types of Pain Medicines

If you are suffering from mild pain, it is likely that a prescription or OTC non-steroidal anti-inflammatory medication will be recommended. If you have moderate pain or anything higher, you may need prescription pain medicine. The following is a list of drugs within these classes:

  • NSAIDs: These drugs target the pathways that control inflammation, which is the body’s way of telling your system that something is wrong. Pain is our natural alarm system that functions to warn us that there is something going on in the body. These medications block those inflammatory signals and decrease the intensity of that “alarm”. Some are more effective than others and some have some unwanted side effects, especially after surgery. For example, aspirin is a potent anti-inflammatory but it also inhibits platelet function, making you for prone to bleed. These medicines are typically given by mouth.[2]
  • Opioids: These drugs are narcotic pain medicines that are in the same class as morphine. They are typically given when NSAIDs cannot be used, when pain is not controlled by other medicines and when very fast pain control is desired. There are several different medications within this class and they can be given by various routes including oral, intravenous, intramuscular, topical creams, transdermal patches and subcutaneous.[3]

There are even medicines that combine opioids and NSAIDs to more effectively control all aspects of pain, including the pain itself and the inflammation that is causing it. They are very effective at managing pain and various dosage levels are available.

Never take more pain medication than is prescribed by your doctor. Do not drive or try to operate any heavy machinery while using these pain medications, as you reaction time and motor skills may be impaired. Please remember not to mix narcotic pain medicines with alcohol, as the effects of the medicines can be altered when doing so, as your body cannot metabolize both substances as effectively.

Medications and Side Effects[4]

Name of the drug/medication Type When to use Route Side Effects
Acetaminophen (Tylenol, etc)  Aminophenol derivativeNSAID Mild pain, body aches, fever Oral, Block pain impulses allergy
Aspirin NSAID Moderate to severe pain Oral, irreversible COX 1 and 2 inhibitor Gastrointestinal tract issues, bleeding
Celebrex NSAID Moderate to severe Oral,  COX-2 inhibitor Gastrointestinal  tract issues, bleeding
Codeine Opium derivative Mild to moderate pain Oral Drowsiness
Felecainide (Tamocor) Antiarrhythmic agent Moderate to severe Oral to relieve nerve pain Dizziness, heart problems, fainting, allergic reactions, blurry vision
Fentanyl citrate (Actiq, Fentora, etc.) Narcotic opioid Moderate to severe pain Patch, lollipop, IV Confusion, euphoria, sedation, somnolence, seizures, anxiety, arrhythmia, constipation
Hydrocodone combination of opioid and acetaminophen Moderate to severe pain Oral, syrup Dizziness, nausea, sweating, respiratory depression, anxiety, somnolence, anxiety, vomiting, constipation
Hydromorphone (Dilaudid, Exalgo) Opioid Moderate to severe pain IV, IM, SQ Respiratory depression, nausea, vomiting, constipation
Ibuprofen   NSAID Mild to moderate pain Reduces inflammation GI bleed, nausea, liver toxicity
Levorphanol (Levo-Dromoran) Opioid Severe pain Oral Respiratory depression, abdominal pain. Sweating, nausea, vomiting, constipation
Morphine Opioid  analgesic Moderate to severe pain Oral capsule, suppository, IV, IM, SQ dizziness, euphoria, light-headedness, somnolence, seizures, cardiac arrest, respiratory arrest, constipation
Naproxen NSAID Mild to moderate pain Oral suspension, tablet, suppository Tinnitus, dizziness, headache, hyperkalemia, rash
Oxycodone (Oxycontin, Roxicodone, etc.) Opioid Moderate to severe pain Oral, syrup Bradycardia, respiratory depression, constipation, vomiting, nausea
Percocet Opioid and acetaminopen Moderate to severe pain Oral Respiratory problems, dizziness, nausea, drowsiness, convulsions, jaundice, upset stomach, constipation
Percodan Opioid and aspirin Moderate to severe pain Oral Respiratory problems, dizziness, nausea, drowsiness, easy bruising, headache, dry mouth, bowel issues

Conclusion

Cancer treatment will have some pain associated as a result of surgery, chemotherapy or radiation treatment, as well as the cancer itself. Be open and honest with your doctor about your pain and they will help determine which medications are best for you. If one pain medication worked initially but no longer works, let your doctor know and they can make changes. With open communication about your pain, you can play an active role in your pain management and continued healing during your breast cancer treatment process.

References

1 Alschuler, L. N. and Gazella, K. A. (2010). The Definitive Guide to Cancer. An Integrative Approach to Prevention, Treatment and Healing 3rd edition. Berkley: Celestial Arts.

2 Hirshaut, Y; and Pressman, PI (2008). Breast Cancer. The Complete Guide. 5th edition. New York: Bantam Books.

3 Turkington, C; and Krag, K (2005). The Encycopedia of Breast Cancer. New York: FOF.

Nurses 2010 Drug Handbook (2010). New York: Lippincott and Wilkins.

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.