Painkillers and ways of taking them

Painkillers are medicines to manage pain. They are also known as analgesics. There are many types available and different ways of taking them.

Painkillers are usually taken by mouth as tablets or capsules. If you find swallowing difficult, you can often get them in liquid form or as pills that dissolve in water.

You may be given painkillers in other ways such as skin patches, gels, nasal sprays or suppositories. Buccal and sublingual medicines dissolve in the mouth and act quickly, so they are often used for breakthrough pain. Injections and drips can also be used.

If you need strong painkillers over a period of time, a small pump called a syringe driver is used. This releases a dose of painkiller at a constant rate.

Always tell your doctor or nurse if you have pain, or if your pain gets worse.

Painkillers for controlling cancer pain

Painkilling drugs are known as analgesics. There are many painkillers available to treat different types and levels of pain.

There are other medicines called adjuvant drugs that are often given with painkillers to help relieve pain. These include bisphosphonates, steroids and anti-depressants.

Your medical team will aim to find the right combination of medicines for you. They will find out how the pain is affecting you by doing a pain assessment.

Some people with cancer have constant pain, so they need to take painkillers regularly to keep the pain under control. If this is your situation and you are prescribed painkillers, it’s important to take them at regular intervals. This is to make sure the medicines work as well as possible.

It’s important to tell your doctor or nurse if your pain gets worse. Don’t let your pain increase until it becomes severe. Severe pain can cause fear, anxiety and make it difficult to sleep. These things can make the pain worse and more difficult to control.


Ways of taking painkillers

Tablets and capsules

Painkillers are mostly taken by mouth, either as tablets or capsules. If you find it hard to swallow, many painkillers are available as liquids and some can be dissolved in water. If you have a feeding tube, some liquid or soluble painkillers can be given through it.

Skin patches and gels

Painkillers can be absorbed through the skin. Patches put onto the skin slowly release painkiller over a few days. You can rub a gel onto the skin to relive pain in one area.

Buccal and sublingual medicines

These are painkillers that are absorbed through the lining of your mouth, so they don’t have to be swallowed. They are either put in the side of your cheek (buccal) or under the tongue (sublingual).

Suppositories

These are inserted into the back passage (rectum).

Nasal sprays

Some painkillers can be sprayed into the nose.

Gas and air (Entonox®)

This is a painkiller that’s breathed in. It is sometimes used during painful procedures, such as a bone marrow test or dressing change. Gas and air is only available in hospitals.

Injections and infusions

Some painkillers can be given by injection, either into a muscle, vein or under the skin (subcutaneously).

Painkillers can also be given by infusion over a period of time. There are different ways of giving painkillers by infusion:

  • Subcutaneous infusion – This involves giving a continuous dose of a drug or drugs through a fine needle placed just under the skin. A small, portable pump called a syringe driver is used to give the drugs.
  • Intravenous infusion – After surgery, some people may have a continuous dose of painkiller given into a vein (intravenously) through a pump. This is called patient-controlled analgesia (PCA). It is only used in hospital for short-term pain control.
  • Epidural and intrathecal analgesia – These may be used to relieve pain after surgery. Sometimes they can be used to help people with cancer pain that is difficult to treat. An anaesthetist puts a fine tube into your back and connects it to a pump that gives you a constant dose of medicine.


Syringe drivers for painkillers and other medicines

A syringe driver is a small, portable pump that can be used to give you a continuous dose of your painkiller and other medicines. You may use one if you are being sick or you can’t swallow. Your doctor or nurse will let you know if you need a syringe driver.

The painkiller is put into the syringe, and the syringe is put into the driver. It is attached by a long tube to a fine needle or cannula that is placed just under the skin. A small dose of the drug is then released at a constant rate for as long as you need it. The syringe is usually changed every 24 hours by a nurse.

Syringe drivers are portable so you can move around as usual. The drivers are battery powered and can clip onto a belt, or fit into a pocket or bag. Or they can be placed in a specially designed holster (holder) that fits under your arm. Other medicines, such as anti-sickness drugs, can also be given through the syringe driver.

Some people worry that if they have advanced cancer and need a syringe driver, this could shorten their life. This isn’t true. A syringe driver is simply a different way of giving drugs, at the dose you need to control your symptoms.