Medications Used for Pain Relief The type of medication and the method of administration are determined by the cause of the pain. For example, chronic pain can be effectively relieved by pain medications that release a steady dose over a long period of time, such as skin patches or extended-release capsules. Medications that work quickly and stay in the body for a short time are effective for sudden onset pain. The following is an overview of the types of pain medications, with more detailed explanations in later sections. Medications used for mild and moderate pain Non-opiate: acetaminophen and non-steroidal anti-inflammatory drugs such as aspirin, paracetamol and ibuprofen are often used. This medication is available both over-the-counter and prescription. Over-the-counter drugs you can buy directly from the pharmacy, while prescription drugs require a check and a prescription to buy. These medications can lower blood clotting, so surgery and chemotherapy can cause problems if you take them while you are on them. This type of medication can also cause some harmful reactions if used with other medications. Medications used for moderate to severe pain Opiates (or narcotics): morphine, fentanyl, codeine, oxycodone hydrochloride, hydromorphone, etc. All of these medications belong to the narcotic control class of drugs that require a doctor’s prescription and are generally not available at a regular pharmacy. Non-opiate painkillers are often used in combination with opiate painkillers to provide the best treatment for moderate to severe pain. Medications used for sudden onset pain Rapid-release opiates: fast-acting oral morphine; fast-acting fentanyl (often administered by holding it under the tongue without swallowing it) These medications also require a prescription and are also narcotic controlled drugs. They are often used in combination with long-acting painkillers. Medications for tingling and burning pain Antidepressants: amitriptyline, nortriptyline, desipramine, and others Antidepressants can relieve certain types of pain. These medications are also prescription drugs and psychiatric controlled substances. Just because you take these medications does not mean you have depression or other psychiatric disorders. Anticonvulsants (anti-seizure medications): carbamazepine, gabapentin, phenytoin, etc. These medications are prescription medications that, in addition to their anticonvulsant effects, are also effective for tingling and burning scintillating pain. Medications used for pain caused by swelling and pressure Steroid medications: prednisone, dexamethasone These medications are prescription medications that are often used to reduce edema, which often causes swelling and pain. Common questions about taking pain medications How do I use pain medications? Some people think that they need injectable pain medication if their pain is severe. In fact, injectable painkillers are rarely used to relieve cancer pain. There are many ways to use pain relievers. Oral – This means that the pain medication is taken by mouth, i.e. it can be swallowed or held in the mouth. This type of painkiller is usually a liquid, tablet, capsule, or mucous membrane-piercing dosage form Skin patches-This type of dosage form releases the medication slowly and continuously through the skin, with an onset of action of up to 2-3 days. This medication rarely causes nausea and vomiting. Rectal suppositories-This drug is broken down in the rectum and absorbed by the body. Injectable pain medications Subcutaneous injection – the medication is injected under the skin using a small needle Intravenous injection – the medication is injected directly into a vein through a syringe, infusion set, or catheter Intra- and epidural injections – the medication is injected into the fluid surrounding the spinal cord (intradural spinal fluid) or into the space around the spinal cord (epidural) Pain pumps or self-contained pain relief systems-Using this method you can control the dose of pain medication. When you need to relieve pain, you press a button to inject a certain amount of pain medication through an automatic pump (the pain pump can precisely control the amount of pain medication that enters your body per unit of time, preventing overdose). The pain pump is attached to a vein, under the skin, or around the spinal cord through a thin catheter. What are the side effects of pain medications? Every pain medication has its side effects, even the ones you can buy over-the-counter at the drugstore. Things like aspirin and ibuprofen can irritate the gastrointestinal tract causing discomfort and even bleeding, so they are usually taken with meals. Detailed drug side effects are described in later sections. Many side effects from opiate pain medications can be prevented. Constipation, for example, is easier to prevent than to treat. Most doctors will start preventing constipation while you are using opiate pain medicines. Certain mild side effects, such as nausea, itching, and drowsiness, go away gradually as your body regulates itself to the medication, even without treatment. If you have any side effects, tell your doctor or nurse for help. Serious side effects of pain medication are rare. They usually occur in the first few hours of using the medicine. They include breathlessness, dizziness and rash. You must see your doctor if these occur. If you use sedative medications, antispasmodic medications, and alcohol, this increases the risk of opiate side effects. The combination of these drugs and opiates can even lead to death in severe cases. Tell your doctor about the opiate painkillers you are taking when you are ready to take them. Keep in mind that you generally should not take non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen during chemotherapy. If you are undergoing cancer treatment, tell your doctor before taking over-the-counter painkillers. Can taking two different opioids cause more serious side effects? This is usually not a problem. In fact, long-acting and short-acting medications are often used in combination so that there will be fewer side effects. Most people have only a few episodes of pain in a day, and the episodes are more severe than chronic pain. Short-acting painkillers can be taken in this case, with other medications taken only when needed. The side effects of taking short-acting drugs in most cases are similar to those of long-acting drugs. What kind of pain medication will I be given? In most cases, non-opiate pain medications are available to meet your pain relief needs. These medications are much more effective at relieving pain than you may realize. For example, a certain dose of oral opiate painkillers is no more effective than regular doses of 2-3 aspirin, paracetamol or ibuprofen per session. If non-opiate pain medication does not relieve your pain, this is when opiate pain medication needs to be given. Some painkillers contain both opiate and non-opiate medicines. To take these medications, you will need a prescription from your doctor who will calculate the dosage of these medications for you to use safely. Other antidepressants and anti-spasmodic medications can also be used for certain types of pain. Non-opiate painkillers Non-opiate painkillers are used for mild to moderate pain. Some non-opiate painkillers are over-the-counter and can be bought over the counter. Trade names and generic names of medications Many medications will have three names. Trade name, generic name, and chemical name. Drug companies will give the drugs they produce a trade name, and some products even have several trade names. You should know that the same trade name will be used for different drugs because the name belongs to the company. You may want to read the label to find out what the drug is made of; chemical names are usually long and awkward. The Food and Drug Administration gives each drug a generic name, which is generally shorter and known by many people. Many pain medications are often known to be used by both generic and trade names. Your doctor, nurse, and pharmacist will tell you the generic and trade names of the medications you take. It is also beneficial to know these names because some people will use another name when talking about these medications. Knowing both names of the medications will also prevent you from getting confused when you are making a record of your medication use. Drugs with generic names may be cheaper than drugs with trade names. Sometimes drugs have the same generic name but are manufactured by different companies, so they have different trade names. And there is also a slight difference in absorption by the body. Therefore your doctor may sometimes recommend that you take a drug with a certain trade name. Consult your doctor whether you should use a cheaper version of the same drug. On top of the main ingredient (e.g. aspirin, paracetamol or ibuprofen), certain trade name pain medicines contain substances called additives. These generally include the following ingredients: 1) caching agents (e.g. magnesium carbonate, aluminum hydroxide), which have the effect of reducing gastrointestinal irritation 2) caffeine, which has a stimulant and pain-reducing effect 3) antihistamines, which have a relaxing and sleep-improving effect. Drugs that contain additives can have side effects that you wouldn’t expect from the main ingredient. For example, antihistamines sometimes cause drowsiness, which is perfectly normal if you rest at night, but can become a problem during the day. Also additives may increase the cost of the medication. They may also interfere with the absorption and alter the action of other medications. So when you start a new medication you should consult your doctor or pharmacist whether the use of this medication at the same time as the medication you are using may cause harmful effects. Aspirin, acetaminophen, or ibuprofen alone may work just as well as their counterparts with additives. However, if you find that a drug with an additive under a certain trade name is more effective, talk to your healthcare team about whether the additive is safe for you. Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs work in much the same way as aspirin. They can be used alone or in combination with other medications. This medication has the ability to control pain and inflammation. Before you take this medication or any other non-opiate medication, talk to your doctor about whether it is safe to use it along with other medications and how long you can take it. Precautions for taking non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs may add certain problems in some people. Non-steroidal anti-inflammatory drugs should usually be avoided by people who: 1) are allergic to aspirin or other non-steroidal anti-inflammatory drugs 2) are undergoing chemotherapy 3) are taking steroid medications 4) are taking medications for lowering blood pressure 5) have or have a history of stomach ulcers, gout, or clotting abnormalities 6) are taking prescription medications to treat arthritis 7) using oral medications for diabetes or gout 8) having kidney disease 9) planning surgery within a week 10) taking blood-thinning medications 11) taking medications that contain lithium Beware of mixing non-steroidal anti-inflammatory drugs and alcohol: Taking non-steroidal anti-inflammatory drugs while drinking alcohol may cause stomach upset and increase the risk of stomach bleeding. Smoking may also increase this risk. Non-steroidal anti-inflammatory drugs may increase the risk of heart attack, especially if you take them for a long time. Side effects of non-steroidal anti-inflammatory drugs 1) The usual side effect of taking non-steroidal anti-inflammatory drugs is stomach upset, especially in older people. Taking them after a meal or a snack can reduce the chances of stomach problems. Ask your doctor to tell you which non-steroidal anti-inflammatory medications have fewer of these side effects. 2) Non-steroidal anti-inflammatory drugs affect platelet function. Platelets have the function of promoting blood clotting during trauma. When platelet function is inhibited, it takes longer for the wound to stop bleeding. Non-steroidal anti-inflammatory drugs irritate the stomach and can cause bleeding. If you notice darkening of your stools or other unusual bruising (which are signs of bleeding), tell your doctor. 3)Other side effects include kidney damage and stomach ulcers, as well as fluid retention and aggravated heart failure. 4)Non-steroidal anti-inflammatory drugs may also affect the action of other medicines, as well as some rare side effects in certain special populations. Paracetamol (acetaminophen) Paracetamol has the same pain-reducing effect as non-steroidal anti-inflammatory drugs, but it does not have the effect of reducing the inflammatory response. Side effects are rare with usual doses of paracetamol. However, if paracetamol is used in large quantities over a long period of time or in regular doses along with alcohol it may damage liver and kidney function. Even small amounts of alcohol may cause liver damage in people taking paracetamol. You may want to know if paracetamol is in the medicines you are taking, see later in this section. Your doctor may not agree to you taking paracetamol during chemotherapy because it may mask a fever. Doctors need to know about fever during chemotherapy, which may be caused by an infection that needs to be treated promptly. Other medicines containing aspirin, paracetamol and ibuprofen Some opiates also contain aspirin or paracetamol, and rarely ibuprofen. Not knowing about these can be dangerous when you take them. If your doctor won’t let you take aspirin, paracetamol and ibuprofen, or if you can’t take these medicines for some reason, it is important to read the instructions for the medicines carefully to understand their ingredients when taking other medicines. If you need to take any over-the-counter medication for a cold, sinus pain or menstrual pain while you’re taking painkillers, make sure you read the instructions carefully. Most such medicines contain ingredients such as aspirin, paracetamol or ibuprofen. Opiate painkillers These medications are used alone or in combination with other non-opiate painkillers for moderate to severe pain. Opiates exert their pain-relieving effects by acting similarly to endorphins (also known as androphen) produced by the body. Opiates work better than other drugs for severe pain. These drugs were once extracted from the poppy flower, but now many are synthetic. Generic names of common opiates (trade names in parentheses) 1) Codeine 2) Methadone 3) Morphine 4) Fentanyl 5) Hydrocodone 6) Morphine oxide There are also some morphine drugs that contain paracetamol or non-steroidal anti-inflammatory medications (e.g., aspirin) Tolerance of opiates People taking opiates for pain sometimes find that they need to increase the dosage of their medication after a period of use. This may be either a worsening of the pain or the development of drug tolerance. Drug tolerance is due to the body’s adaptive response to the medication, when a larger amount of the medication is needed to provide the same pain relief as the original smaller dose. Many people may not develop tolerance, but if this occurs, a slight increase in the dose of the medication or a change in the type of medication will usually help to reduce the pain. Increasing the dose of an opiate to relieve pain or to overcome a drug tolerance does not mean becoming addicted to the drug. How do I use opioids to get a desired pain relief? When a certain dose of a medication does not provide satisfactory pain relief, your doctor will increase the dose or frequency of the medication. Only after close communication with your healthcare team, your doctor may give you a larger dose to relieve pain. Do not increase the dose of your pain medication on your own. If this change in dose is not effective, your doctor may also put you on another medication or in a combination of plus one medication. There is also a difference in pain relief between opioids, and you may need an opioid with a stronger pain relief effect. If your pain relief doesn’t last long enough, you can ask your doctor for a longer-acting opiate pain medication. These medications include morphine and Oxycodone.Also some skin patches of the slow-release opiate fentanyl are available. If your pain is effectively controlled most of the time, but sometimes there are occasional bouts of pain, this is when your doctor may give you a fast-acting painkiller such as fast-acting morphine. This will give you fast pain control when your pain flares up. Taking Opiate Painkillers Safely When taking opiate painkillers, your doctor will carefully watch and adjust the dose and usage of opiate painkillers to prevent overdose. For this reason, it is very important to take your medication as prescribed by only one doctor. If you are under the care of several doctors, don’t go on opiates until they have communicated. If you drink alcohol or take tranquilizers, sleeping pills, antidepressants and antihistamines, and other medications that have a sleeping effect, tell your doctor about your use. Drinking alcohol or using these drugs and opiates together may be dangerous. Even small doses may cause some problems. Weakness from overdose drinking, trouble breathing, confusion, anxiety, or drowsiness and dizziness may occur with combined use. Side Effects of Opiate Painkillers Not everyone has side effects when using opiate painkillers. The most common side effects are drowsiness, constipation, nausea, and vomiting. Some people may also have dizziness, itching and psychotic reactions (such as nightmares, confusion and hallucinations), slow shallow breathing and difficulty urinating. Drowsiness Your first dose of opiate painkillers may cause drowsiness, but this side effect fades after a few days. If pain is interfering with your sleep, your sleep will increase significantly today after you start taking the medication. Drowsiness will also decrease as your body adjusts to the medication. You should tell your doctor if you feel drowsiness manifesting itself during normal activities again a week after taking the medication. It is sometimes unsafe to drive or walk up and down stairs alone while taking opiates, and you should also avoid operating large equipment and participating in activities that require you to maintain a sensitive response. Here are some ways to cope with drowsiness: 1) Wait a few days and watch to see if this goes away 2) Check to see if other medications you are taking also have a drowsiness-causing effect 3) Ask your doctor if you can take small amounts several times or use extended-release opiates 4) If this opiate medication isn’t effective at controlling the pain, this is when switching to a better medication may have fewer drowsy side effects 5) Sometimes it’s better to slightly lowering the dose of opioids can maintain pain control and reduce the side effect of drowsiness. If the drowsiness is severe, you may be taking more of the drug than you need. Talk to your doctor about lowering the dose of your medication. 6) Ask your doctor whether to switch to a different opiate 7) Ask your doctor whether you can can take mild stimulants, such as coffee 8) If drowsiness worsens or suddenly develops after you have been taking opiates for some time, contact your doctor promptly Constipation Opiates cause constipation in most patients. This is due to the fact that opium slows down the movement of intestinal contents, which results in water being absorbed by the body for a longer period of time and stools becoming hard. Therefore when you start taking opiates regularly, it is best to use laxatives, stool softeners or other medications that promote bowel movement. Constipation can mostly be prevented and controlled. After being examined by your doctor, try the following to prevent constipation: 1) Talk to your doctor about laxatives and stool softeners to learn about their use 2) Drink plenty of water; 8-10 glasses of water a day can help soften stools. If dry stools become hard, drinking water to soften them is an important step 3)Eat high fiber or roughage foods such as unpeeled fruits, vegetables, whole grain breads and cereals 4)Add 1-2 tablespoons of unprocessed bran to your food at mealtimes, this promotes bowel movements. Make sure you drink plenty of water to soften the contents of your intestines while eating this food 5) Exercise whenever possible. Consult your doctor about the kind of exercise that is adapted to you. If you haven’t exercised lately, walking is the best way to start 6) Eat foods you have used in the past that have been shown to reduce constipation 7) If you are bedridden for long periods of time, try going to the restroom or bedside commode If you are still constipated after trying all of the above, ask your doctor to change the laxatives and stool softeners. Talk to your doctor before taking any laxative or stool softener. If you do not have a bowel movement for more than 2 days, you need to see your doctor. Nausea and vomiting Nausea and vomiting caused by opioids mostly go away a few days after taking the medicine. The following methods can help reduce this side effect. 1) If this side effect is more likely to occur when you stand or walk to and less when you lie down, you can lie in bed for an hour after taking the medicine. This nausea is similar to exercise vomiting. Sometimes some over-the-counter medicines such as meclizine (bonine or antivert) or dimenhydrinate (dramamine) help to reduce this side effect. However, it is important to get your doctor’s permission before using these medications, as they can also cause certain problems in some people. 2) If the pain itself is caused by nausea and vomiting, taking opiates to relieve the pain will relieve the nausea and vomiting at the same time 3) There are also some prescription medications that are used to relieve nausea and vomiting if you need them. If nausea and vomiting cause you to be unable to eat for a whole day or if the condition persists for several days, you should talk to your doctor to get help. 4) Ask your doctor if the nausea and vomiting are caused by cancer, other medical problems, steroid medications, chemotherapy drugs, or aspirin. Constipation can also aggravate nausea and vomiting Some people think that nausea and vomiting after taking opiates is a sign of an allergy. Nausea and vomiting alone is not an allergic reaction. However, if nausea and vomiting are accompanied by a rash or itchy skin, it may be an allergic reaction. Stop taking this medication immediately if these occur, and stop the medication immediately and get medical help if you have an itchy rash, difficulty breathing, or swelling of the throat. How do I stop taking opiates? You cannot stop taking opiates suddenly. If you are going to stop taking opiates, it is usually better to gradually reduce the dose or frequency so that your body adjusts to the change. If you stop taking opioids suddenly, you may experience flu-like symptoms, excessive anxiety, diarrhea, or other rare manifestations. These symptoms can be treated but generally resolve after a few days or weeks. A slow and gradual reduction in the dose of the medication can prevent these from occurring. Other types of pain medications Different types of medications are used instead of or in combination with opiates to relieve cancer pain. These medications are effective in reducing pain but increase opiate side effects, while others reduce side effects. The following medications may be recommended by your doctor. 1) Antidepressants. 2)Antihistamines. 3)Anti-anxiety medications. 4)Stimulants and amphetamines. 5)Anti-spasmodic drugs. 6)Steroid hormones.