Overcoming cancer pain


Using pain medicines

Wednesday 13 February, 2019

Medicines that relieve pain are called analgesics (also known as pain medicines, painkillers and pain relievers). These drugs do not affect the cause of the pain, but they can reduce pain effectively. The medicine that is best for you depends on the type of pain you have and how severe it is. Your medical team will also balance the expected pain relief against possible side effects and their impact on your quality of life.

Levels of pain control

There are different types and strengths of pain medicines suitable for different levels of pain.

Mild

  • Suitable for pain less than 3 on the pain scale.
  • Examples include paracetamol and non- steroidal anti-inflammatory drugs (NSAIDs).
  • See more information.

Mild to moderate

  • Used for pain that is 3-6 on the pain scale.
  • Examples include weak opioids, e.g. codeine.
  • See more information.

Severe

  • Prescribed when pain is higher than 6 on the pain scale.
  • Examples include strong opioids, e.g. morphine, fentanyl.
  • See more information.

How to use medicines

Take your medicines regularly Taking your medicines as prescribed is the best way to control the pain. Some people call this "staying on top of the pain". Doing this may mean you can use lower doses of pain relief than if you were to wait until the pain gets worse.

If you think your pain medicine isn't working, it's important to let your doctor know - they may need to adjust the dose or prescribe a different medicine.

Give your medicines time to work

Different pain medicines take different amounts of time to work. How long each one takes depends on whether the active ingredient is released slowly or immediately.

Slow release medicines - release the active ingredient continuously to provide pain control for 12-24 hours. They are used for constant pain and need to be taken as prescribed. This helps keep the amount of medicine in the blood high enough to be constant and effective. Also known as sustained release medicines.

Immediate release medicines - release the active ingredient quickly, usually in less than 30 minutes. They are used for occasional, temporary pain because they work fast but don't last.

How quickly different medicines relieve pain also varies greatly from person to person. It depends on how much medicine you take (the dose) and how often you take it (the frequency).

Understand the different types of pain relief

To manage your pain effectively, you may be given a combination of prescription and non-prescription medicines. You may also want to try complementary therapies to improve your quality of life.

Prescription medicines

These are medicines that your doctor must authorise you to take and only a pharmacist can give you (dispense). Most prescription medicines have two names:

  • the generic name identifies the chemical compounds in the drug that make it work
  • the brand name is the manufacturer's name for the medicine.

A medicine may have more than one brand name if it's produced by different companies. See a list of generic and brand names of strong medicines.

Non-prescription medicines

These are available without a prescription, often from pharmacies and supermarkets, and include over-the-counter medicines such as mild painkillers and cold medicines. Vitamin supplements and herbal remedies are also considered nonprescription medicines.

Allied health services

These offer therapies, such as physiotherapy techniques, exercises and psychological therapies, to help people manage their pain.

Complementary therapies

These are therapies that can be used alongside conventional medical treatments to improve your quality of life and wellbeing.

Keep track of medicines

There are different ways to help ensure you take the correct dose of medicine at the right time.

Medicine packs

You can ask your pharmacist to organise your tablets and capsules into a blister pack (e.g. Webster-pak) that sets out all the doses that need to be taken throughout the week, along with a description of each drug.

Medicines list

This records what you need to take, when to take it, how much to take and what each medicine is for. You can:

  • create your own list on paper or on a computer
  • order a printed NPS MedicineWise list to keep in your wallet or handbag at nps.org.au/order
  • download the MedicineWise app from the App Store or Google Play onto your smartphone. You can scan the barcode on packaging to add a medicine to the app and set up alarms for taking the medicine.

Discuss your pain medicines with family and friends

Family members, carers and friends sometimes have opinions about the pain relief you're having. Your family members may feel anxious about your use of strong pain medicines. This may be because they are worried that you will become addicted.

Let your family know how the experience of pain affects you emotionally, and that keeping the pain under control allows you to remain comfortable and enjoy your time with them. You may want to ask your treatment team if they can explain to your family and carers why a particular medicine has been recommended for you.

Ways of taking medicines

Pain medicines are taken in several ways, depending on the type of medicine and the form that it is available in.

tablet or capsule This is the most common form of pain medicine. It is usually swallowed with water.
liquid This may be an option if you have trouble swallowing tablets or for convenience.
lozenge This is sucked on the inside of your cheeks and gums until it dissolves.
injection A needle is inserted either into a vein, into a muscle or under the skin.
skin patch This is stuck on your skin and gradually releases medicine into the body. The patch only needs to be changed every few days.
subcutaneous infusion Medicine is slowly injected under the skin using a small plastic tube and portable pump. This can be given over many hours or days.
intravenous infusion Medicine is slowly injected into a vein over many hours or days using a small plastic tube and pump. You press a button on the pump to release a set dose of medicine. This is called patient-controlled analgesia (PCA). It is used in hospitals under the supervision of a pain specialist.
intrathecal injection or infusion Liquid medicine is delivered into the fluid surrounding the spinal cord. This is commonly used to treat the most severe cancer pain.
suppository A pellet is put into the bottom (rectum). The pellet breaks down and the medicine is absorbed by the body. This may be suitable if you have nausea or trouble swallowing.

Using medicines safely

All medicines may have side effects, particularly if they are not taken as directed. Let your doctor, nurse or pharmacist know if you're taking any other medicines at the same time as your pain relief. This includes all prescription and non-prescription medicines, vitamins, herbs and other supplements. Some medicines may react with each other, causing them to stop working properly or creating harmful side effects. Some effects to keep in mind include:

  • Many pills for colds and flu, and other over-the-counter medicines, can be taken with pain medicines without any harmful effects. However, if they contain paracetamol or anti-inflammatories this counts towards your total daily intake, and you may need to take a lower dose of standalone pain medicine.
  • Medicines for colds, menstrual (period) pain, headaches, and joint or muscle aches often contain a mixture of drugs, including aspirin. People receiving chemotherapy should avoid aspirin because it increases the risk of internal bleeding. Aspirin may also cause minor cuts to bleed a lot and take longer to stop bleeding (clot).
  • Over-the-counter medicines for allergies may cause drowsiness, as can some pain medicines. Taking them together can make it dangerous to drive and to operate machinery.

The Therapeutic Goods Administration (TGA) collects information about medicines and medical devices that haven't worked well. You can search the Database of Adverse Event Notifications (DAEN).

Tips for using pain medicines safely

  • Ask your doctor or pharmacist for written information about your pain medicines: what they are for; when and how to take them; possible side effects and how to manage them; and possible interactions with other medicines, vitamins or herbal and natural remedies.
  • Follow the directions and only take the recommended dose. This will reduce the risk of misuse or accidental overdose.
  • Keep medicines in their original packaging so you and other people always know what they're for. Or ask your pharmacist to put your tablets and capsules into a labelled blister pack.
  • Store medicines in a safe place that is out of reach of children.
  • Take precautions when managing or storing your medicines to avoid potentially dangerous mix-ups.
  • Remind yourself when to take your medicines by writing a note, or setting an alarm or reminder on your phone.
  • Talk to your GP about having a pharmacist carry out a home medicines review. This can help ensure you take all your medicines safely.
  • Check the expiry dates of medicines. If they are near or past their expiry, see your doctor for a new prescription.
  • Take expired medicines or any that are no longer needed to the pharmacy for safe disposal.
  • Check with your health care team whether it's safe to take complementary therapies, such as nutritional supplements, with your pain medicine.
  • Find out more about your medicines by calling the NPS MedicineWise Medicines Line on 1300 633 424.
  • Let your health care team know of any side effects. Call the Adverse Medicine Events Line on 1300 134 237 if you suspect you've had a reaction to any kind of medicine. If you need urgent assistance, call 000 or go to a hospital emergency department.

Travelling with medicines

It's possible to take prescription medicines overseas for your own personal use, but it's best to follow the Australian government's recommendations. As these may change from time to time, check the current recommendations and restrictions before you travel at homeaffairs.gov.au/travelsecure.

A reasonable amount of medicine and medical equipment is allowed under powder, liquid, aerosol and gel restrictions in carry-on baggage. Have any medicines you need during the flight ready for screening at the airport. Pack the rest of your medicines in your checked baggage.

To help you prepare for travelling with medicines:

  • ask your doctor if you need to change your medicine schedule to allow for time differences and if there are limits on the amount of medicines you can take overseas
  • check with the embassies of the countries you're visiting and with the travel advice at smarttraveller.gov.au to make sure your medicine is legal there
  • make sure you have enough medicines to cover the whole time you're away, and pack a few extra doses in case you are delayed
  • carry a letter from your doctor outlining each medicine, how much you'll be taking, and any equipment such as hypodermic needles or gel packs, and stating that the medicine is for your personal use
  • keep medicines in their original packaging so they can be easily identified, and make sure the name on the medicines matches the name on the passport
  • call the Travelling with PBS Medicines Enquiry Line on 1800 500 147 for more information.

Expert content reviewers:

Dr Tim Hucker, Clinical Lead, Pain Service, Peter MacCallum Cancer Centre, and Lecturer, Monash University, VIC; Carole Arbuckle, 13 11 20 Consultant, Cancer Council Victoria; Anne Burke, Co‑Director, Psychology, Central Adelaide Local Health Network, SA, and President Elect, The Australian Pain Society; Kathryn Collins, Co-Director, Psychology, Central Adelaide Local Health Network, SA; A/Prof Roger Goucke, Head, Department of Pain Management, Sir Charles Gairdner Hospital, Director, WA Statewide Pain Service, and Clinical A/Prof, The University of Western Australia, WA; Chris Hayward, Consumer; Prof Melanie Lovell, Senior Staff Specialist, Palliative Care, HammondCare Centre for Learning and Research, Clinical A/Prof, Sydney Medical School, and Adjunct Professor, Faculty of Health, University of Technology Sydney, NSW; Linda Magann, Clinical Nurse Consultant, Palliative Care and Peritonectomy Palliative Care, St George Hospital, NSW; Tara Redemski, Senior Physiotherapist, Gold Coast University Hospital, Southport, QLD.

Download PDF Order FREE booklet

Talking bubbles icon

Questions about cancer?

Call or email our experienced cancer nurses for information and support.

Contact a cancer nurse