Discomfort from lung cancer may arise from the size and location of tumors and subsequent pressure on surrounding tissues, or from symptoms such as coughing. Lung cancer treatments, such as chemotherapy, radiation and surgery, frequently produce painful effects as well. Medications work best when they are part of a multifaceted approach to pain management that take into account patient preferences, confidence and convenience.
Non-Narcotic Analgesics
Over-the-counter medications such as acetaminophen, ibuprofen, naproxen and aspirin can control mild to moderate cancer pain when taken regularly, according to the National Cancer Institute. All but acetaminophen also treat inflammation. These medications may pose a risk of masking infection during treatment with chemotherapy, however, because they control fever. Non-narcotic drugs may be an ingredient in short-acting opioid formulas; care should be taken not to exceed the recommended doses.
Opioids
Opioids, or narcotic medications, may be short-acting, long-acting or formulated for immediate release to handle the various circumstances and intensities of pain from lung cancer. Codeine, hydrocodone, hydromorphone and oxycodone are examples of short-acting opioids that can be taken as needed for moderate to severe pain. Opioids also come in sustained relief formulas, such as fentanyl patches. Methadone is a long-acting drug that is slow to metabolize. Either methadone or opiods may be prescribed to replace short-acting medications at times when round-the-clock pain control is needed.
If increasing drug tolerance or worsening disease require more effective pain control, the next step is to increase the dose frequency of long-acting narcotics. Breakthrough pain is defined as a type of pain that has a sudden and severe onset, lasts an average of 30 minutes and may be associated with certain pain triggers, according to an article on evidence-based care published in the December 2006 issue of "American Family Physician." Rapid-acting opioids, such as immediate-release morphine or fentanyl lozenges, can rescue patients from breakthrough pain by providing fast relief that works over and above regular medications.
Neuropathy Medications
Nerve pain, or neuropathy, feels tingly or burning. Lung cancer that compresses or invades neural tissues is a direct cause of nerve irritation, and nerve damage may also be a side effect of surgery, radiation or chemotherapy. Non-narcotic medications traditionally used for other purposes have been found to be effective against this type of pain.
According to an article on the mechanisms, clinical manifestations and therapy of neuropathic cancer pain by Serbian researchers, tricyclic antidepressants are effective against continuous neuropathy, while anticonvulsant drugs alleviate nerve pain that is unpredictable and piercing. The dose of medicine needed to control neuropathy in lung cancer patients may be lower than doses given to treat depression or seizure disorders. A few days to a few weeks may be needed for the medication to become fully effective.
References
- National Cancer Institute: Medicines to Treat Cancer Pain
- "American Family Physician," Opioids for Management of Breakthrough Pain in Cancer Patients, Potter M., December 1, 2006, 74(11)
- "Medicinaski Pregled," Neuropathic Pain due to Malignancy: Mechanisms, Clinical Manifestations and Therapy, Pjevic M., et. al., Jan-Feb 2004, 57(1-2)
