The Mayo Clinic reports that one out of three cancer patients will experience pain. Up to 80 percent of patients with advanced cancer will suffer pain at some point in their disease. Despite the prevalence of pain, it is possible to treat and manage pain effectively. The World Health Organization recommends treating pain with a step-ladder approach. The first tier of the ladder consists of using weaker medications designed to treat mild pain. The next tier up the ladder involves the use of the weaker medications in combination with weak opioid medications. The highest tier on the pain ladder is for severe pain. Severe pain may need strong opioid medications for relief. Movement up the pain ladder is recommended if pain is not relieved at the currently used tier. The World Health Organization also recommends that these medications be given around the clock so that patients are kept out of pain and do not allow it to return.
Analgesics and NSAIDs
Analgesics and non-steroid anti-inflammatory medications are typically used to treat mild pain. Simple analgesic medications include Tylenol and aspirin. Two common NSAIDs include ibuprofen and Aleve. Other NSAIDs, such as Celebrex, are useful for bone pain, which is difficult to treat. Analgesics and NSAIDs are also used to treat discomfort associated with fevers in cancer patients. These medications may need to be taken every four to six hours.
Weak Opioids
On the second tier of the WHO pain ladder are the weaker opioid medications. These medications include hydrocodone, codeine, and oxycodone. These are often paired with Tylenol or ibuprofen by manufacturers for ease of use. Common combination medications used are Vicodin, Lortab, Percocet, and Tylenol 3. These medications tend to come in short-acting forms and are given every four to six hours.
Strong Opioids
When analgesics, NSAIDs and weaker opioids are not effective in managing pain stronger opioids may be required. Strong opioid medications commonly used include morphine, Dilaudid, fentanyl, methadone and oxymorphone. These medications are for severe pain only due to the risk for side effects and their potential dependence. Some of these medications come in extended-release forms that can be taken two or three times a day.
Adjuvant Medications
Adjuvant medications are not designed to eliminate pain but rather to enhance pain medications for further pain relief. There are several kinds of adjuvant pain medications designed for different circumstances. Anti-convulsant medications like Neurontin and Dilantin are useful for pain that involves numbness and tingling. Steroids like Decadron and prednisone are helpful for spinal-cord compression pain and headaches that involve brain swelling. Anti-anxiety and anti-depressants like lorazepam and Xanax work well with other pain relievers for a number of types of pain. They also help with anxiety and depression that is commonly seen in the chronically painful. Medications are also used in cases of painful muscle spasms and include Bentyl, Baclofen and Scopolamine.
References
- National Cancer Institute: Pain Control
- "Core Curriculum for Oncology Nursing"; Itano, J. Ph.D, Taoka, K. MSN; 2005
- Mayo Clinic: Cancer Pain: Relief is Possible
- World Health Organization: Pain Ladder
