Managing pain with medicines

Medicines used to control mild cancer pain include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs). They are often available over the counter from pharmacies without a prescription. These types of drugs can help relieve certain types of pain, such as bone pain, muscle pain, and pain in the skin or in the lining of the mouth. NSAIDs can reduce inflammation or swelling, and be used with stronger pain medicines such as opioids, to help relieve moderate to severe pain. 

Common pain medicines

Paracetamol

Paracetamol is a common drug that is known by various brand names such as Panadol and Panamax. You can have these medicines in tablets, capsules, soluble powders, liquids or suppositories. An adult should take no more than 4 g of paracetamol in 24 hours (usually 8 tablets), unless your doctor says it’s safe to do so. For some people, a lower dose is recommended due to low body weight or liver problems. The maximum dose for children depends on their age and weight, so check with the doctor, nurse or pharmacist.

If taken within the recommended dose, paracetamol is unlikely to cause side effects. Some stronger pain medicines contain paracetamol along with another drug. This will count towards your daily total intake. Taking too much of one type of medicine may lead to an overdose. If you are unsure whether a medicine contains paracetamol, check with your doctor, nurse or pharmacist. In some cases, your doctor will recommend you take paracetamol with other stronger pain medicines, such as oxycodone, to help them work better.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of medicines that include ibuprofen, naproxen, celecoxib, diclofenac and aspirin. They are known by brand names, such as Advil and Nurofen.

You can have these medicines as tablets or sometimes as injections. Less commonly, NSAIDs are given as a suppository. Do not take more than one NSAID medicine at the same time – if you’re unsure, check with your doctor, nurse or pharmacist.

Side effects of NSAIDs

Before taking NSAIDs, ask your doctor if they are suitable for you, as some people are at higher risk of side effects.

Common side effects include nausea and indigestion. Rare side effects include a risk of bleeding in the stomach or intestines, and kidney problems. Some studies show that NSAIDs can cause heart problems, especially if used for a long time or in people who have heart problems.

Talk to your doctor or nurse before taking NSAIDs, especially if you have stomach ulcers, heart disease, kidney disease or gut reflux; are having chemotherapy; or are taking other medicines that also increase your risk of bleeding (such as anticoagulants/blood thinners like warfarin). If you are taking NSAIDs in high doses or for a long time, take them with food to lower the risk of indigestion. You can also ask about using a different type of pain medicine that is less likely to cause indigestion and bleeding, such as paracetamol.

Other medicines

To help manage pain, your doctor may prescribe medicines that are normally used for other conditions. These can work well for some types of chronic pain, particularly pain caused by nerve damage. See the table below for some examples.

These medicines can be used on their own or with opioids at any stage of the cancer diagnosis and treatment. When prescribed with opioids, these drugs are known as adjuvant drugs or adjuvant analgesics. They can increase the effect of the pain medicine.

Adjuvant drugs are usually given as a tablet that you swallow. Some drugs don’t work right away, so it may take a few days or weeks before they provide relief. In the meantime, opioids are used to control the pain. If you are taking an adjuvant drug, it may be possible for your doctor to reduce the dose of the opioids. This may mean that you experience fewer side effects without losing control of the pain.

Your doctor will talk to you about any potential side effects before you start taking a new medicine.

I developed peripheral neuropathy after chemotherapy for breast cancer. The pain from the pins and needles in my hands made it hard to work. The oncologist prescribed an antidepressant to manage the pain, and this worked well. I was able to keep working, which was good for my mental health and wallet.

Tanya

Medicinal use of cannabis

Medicinal cannabis is a medicine that comes from the cannabis plant (also called marijuana). This plant contains many cannabinoids. Two of these – tetrahydrocannabinol (THC) and cannabidiol (CBD) – are found in most medicinal cannabis products.

Cannabinoids are chemicals that act on certain receptors found in the central nervous system. This is similar to how opioids interact with the body.

Research studies have looked at the potential benefits of using medicinal cannabis to relieve symptoms and treatment side effects of cancer. There is some evidence that cannabinoids can help people who have found conventional treatment unsuccessful for some symptoms and side effects, for example, chemotherapy-induced nausea and vomiting.

There is no evidence that medicinal cannabis can treat cancer.

To date, published studies have shown medicinal cannabis to have little effect on appetite, weight, pain or sleep problems. The International Association for the Study of Pain does not endorse the use of medicinal cannabis for pain. Research is continuing in this area.

In Australia, it is illegal to sell cannabis for personal or recreational use. With the exception of the ACT, it is also illegal to grow, possess and cultivate cannabis for recreational or personal use.

The Australian Government has legalised access to medicinal cannabis strictly for medicinal purposes. Australia’s Therapeutic Goods Administration (TGA) regulates the supply of medicinal cannabis. To prescribe this product, doctors must have approval from the TGA.

In most states and territories, any doctor can now apply for approval to prescribe medicinal cannabis, but the laws for obtaining medicinal cannabis vary between states and territories. These laws may affect whether you can be prescribed medicinal cannabis where you live.