People who have pain from cancer that has spread to the bones may find drugs called bisphosphonates helpful. As well as helping to reduce pain, bisphosphonates can also strengthen the affected bones. Bisphosphonates may be given as a drip into a vein, usually once a month, or as tablets.
When pain is caused by a tumour pressing on or damaging a nerve, steroid drugs may help relieve this pressure and so reduce pain. They may be given alone or with other painkillers. Commonly used steroids are dexamethasone and prednisolone.
Although they generally make you feel better, they may also increase your appetite. Steroids may make you put on weight, and they can increase your risk of getting infections.
The levels of sugar in your blood may also change temporarily. Tell your doctor or nurse if you become very thirsty and start going to the toilet to pass urine more often, as this may be due to an increase in your blood sugar level.
Some people find that steroids make them feel agitated or irritable because they make the mind more active. Steroids can make it more difficult to sleep, but this is less of a problem if they are taken in the morning. The side effects disappear gradually once treatment is over. Steroids can also cause indigestion and may irritate the lining of the stomach (sometimes causing bleeding), so it’s important to take them after a meal or snack. Your doctor may prescribe other tablets in addition to the steroids to help protect your stomach.
Antiepileptic and antidepressant drugs
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Antiepileptic drugs such as gabapentin, pregabalin or carbamazepine or low-dose antidepressants such as amitriptyline can help reduce pain caused by nerve damage. This type of pain is called neuropathic pain. The dose of these medicines may need to be gradually increased over a few days or weeks to control the pain, so it’s important to continue taking them even if they don’t work straightaway.
Some people worry that if they’re started on low doses of antidepressants for nerve pain, it’s because their doctor thinks they’re depressed, but this isn’t the case; research has shown that low doses of antidepressants are effective for nerve pain, but higher doses are needed to treat depression.
Some people find that the antidepressant amitriptyline can make them feel sleepier or slightly ‘hungover’. If this happens to you, let your doctor or nurse know. You should also make sure you take the dose at night to prevent you from feeling drowsy during the day.
When pain is due to an underlying infection, your doctor will likely prescribe you antibiotics to treat the infection.
If muscle spasms are making your pain worse, you may have a short course of a drug, such as diazepam (Valium®), baclofen (Lioresal®) or clonazepam (Rivotril®), to help relax the muscles.