Other medicines to help control pain

Some drugs are prescribed with painkillers to help control pain. These are often known as adjuvant drugs. They work in different ways. Some of the drugs used are:

  • Bisphosphonates, which strengthen bones affected by cancer and reduce bone pain.
  • Denosumab, which reduces bone pain and the risk of fractures if cancer has spread to the bones.
  • Steroids, which can reduce swelling and pain caused by a tumour pressing on a part of the body.
  • Anti-epileptic and anti-depressant drugs, which can reduce pain caused by nerve damage.
  • Antibiotics, which can help if pain is caused by an infection.
  • Muscle relaxants, which can be given if muscle spasms are making pain worse.

You may have other medicines that are not mentioned here.

It may take a while to find the drugs that work best for you. Talk to your doctor or nurse if you are still in pain or have side effects.

What are adjuvant drugs?

You may be prescribed other medicines to take with painkillers. These are often known as adjuvant drugs and may include those listed below. 


Bisphosphonates

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. You can have them as a drip into a vein, usually once a month, or as tablets. Commonly used bisphosphonates are:

  • sodium clodronate (Bonefos®, Clasteon®, Loron 520®)
  • ibandronic acid (Bondronat®, Bonviva®)
  • disodium pamidronate (Aredia®)
  • zoledronic acid (Aclasta®, Zometa®).


Denosumab

Denosumab (Prolia®, Xgeva®) is a treatment that reduces bone breakdown. It may be used to lower the risk of broken bones, and to relieve pain if cancer has spread to the bones. You have it as an injection just under the skin, every four weeks.


Steroids

You usually have steroids as tablets, but they can also be given as an injection. They can reduce swelling and pain caused by a tumour pressing on a part of the body. There are many types of steroids. Usually people are given prednisolone or dexamethasone.


Anti-epileptic and anti-depressant drugs

Some anti-epileptic drugs (such as gabapentin, Neurontin®; or pregabalin, Lyrica®) and some low-dose anti-depressants (such as amitriptyline) can help reduce pain caused by nerve damage. This type of pain is called nerve pain. These medicines are usually taken as tablets or capsules.

The dose of these medicines may need to be gradually increased over a few days or weeks to control the pain. This means it’s important to continue taking them, even if they don’t work immediately.

Some people worry that if they are given anti-depressants for nerve pain, it’s because their doctor thinks they’re depressed. This is not the reason. Research has shown that low doses of anti-depressants are effective for nerve pain.

The anti-depressant amitriptyline can make some people feel sleepy or slightly ‘hungover’. If this happens to you, tell your doctor or nurse. You could take the dose at night to stop you feeling drowsy during the day.


Antibiotics

When pain is caused by an infection, for example an infected wound, your doctor may prescribe antibiotics to treat the infection.


Muscle relaxants

If muscle spasms are making your pain worse, you may have a short course of a drug to help relax the muscles.

Commonly used muscle relaxants are:

  • diazepam (Valium®)
  • clonazepam (Rivotril®)
  • baclofen (Lioresal®)
  • hyoscine butylbromide (Buscopan®).


Finding the right medicine for you

You may have other medicines that are not mentioned here. Ask your doctor or specialist nurse if you have any questions or are unsure about any of your prescribed medicines.

It is important that you have as little pain as possible. The key is to reduce your pain to a level that you can manage, so that you can get on with your life. Sometimes it may take a little while to find the drugs that suit you best and relieve your pain. Talk to your doctor or nurse if you are still in pain or the side effects are bothering you.