Painkillers and cancer
There are different types of painkillers and ways of taking them. Your medical team will find the best painkiller for you.
Painkilling drugs are sometimes called analgesics. To make it easier to understand, we use the term painkillers in this content. There are many painkillers available. They can treat different levels and types of pain.
There are other drugs you often have with painkillers to help relieve pain. For example, drugs to treat nerve pain, drugs for bone pain called bisphosphonates, and steroids. Your doctor or nurse will regularly assess the pain to find the right combination of medicines for you.
You may find it helpful to read our information on some frequently asked questions and answers about painkillers.
If you have had pain for more than a few months, you usually need to take painkillers regularly to control it. Doctors sometimes call this type of pain chronic or persistent pain.
Always take your painkillers at regular intervals exactly as prescribed by your doctor. This is to make sure they work as well as possible for you. The aim is for pain control to be constant. Putting off taking painkillers can make the pain more severe. It may then take longer to get it under control when you do take them.
If you have been given painkillers for breakthrough pain, do not wait for it to get bad before taking them.
It is very important to tell your doctor or nurse if pain gets worse. This means they can treat it before it becomes harder to control. You may need to have your regular dose adjusted, or have a different painkiller. It can sometimes take time to get the right painkiller and dose.
We have more information on different types of pain.
There are a number of ways that painkillers can be taken including:
Tablets and capsules
You usually take painkillers as tablets or capsules. If you find these hard to swallow, many painkillers come 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.
Painkillers can be absorbed through the skin. You put a patch onto the skin, which slowly releases a constant supply of the painkiller over a few days. This can be helpful for people who have difficulty swallowing or remembering to take painkillers regularly.
Buccal and sublingual medicines
These are painkillers that are absorbed through the lining of your mouth so you do not have to swallow. You put them in the side of your cheek (buccal) or under your tongue (sublingual).
As an injection
You can also have painkillers as an injection under the skin (subcutaneous), into a muscle or directly into a vein (intravenous).
These are inserted into the back passage (rectum).
Gels or creams you put on skin
If the pain is in one area (local), rubbing a gel or cream onto the skin may help relieve it. For example, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, are available as gels. There are also gels or plasters that contain local anaesthetics. These are sometimes helpful.
Creams containing menthol may help with muscle pain. Another cream called capsaicin may be used to treat nerve pain. Capsaicin is the substance that makes chilli peppers hot. Your doctor needs to prescribe this.
Do not use any gels or creams on skin that is inflamed or broken. Wash your hands after applying any cream or gel.
Some painkillers can be sprayed into the nose.
Gas and air (Entonox®)
This is a painkiller that you breathe in. You sometimes have it before procedures, such as a bone marrow test or a dressing change, to reduce pain. It is only available in some hospitals.
Having painkillers through a pump
Painkillers are sometimes delivered continuously over a set time through a pump. There are different ways and reasons for doing this. The painkillers can be given in the following ways:
Under the skin
A dose of a painkiller is given under the skin through a fine needle connected to a small pump. This is called a syringe pump. It can be used to manage cancer pain in different situations.
Into a vein through a pump
After surgery, some people may have a painkiller given into a vein through a pump. It is used for short-term pain control.
Into a fine tube in the back (epidural and intrathecal)
A painkiller is given into a fine tube which is connected to a pump. This is done by an anaesthetist and used after certain types of surgery. But it can also be used to control cancer pain that is difficult to manage.
Having a syringe pump
A syringe pump is a small battery-operated pump. It is used to give a continuous dose of painkillers through a needle under the skin for a set time. Other drugs, such as anti-sickness drugs, can be given at the same time. A syringe pump can be used for different reasons, for example:
- if you are feeling or being sick
- if you are having difficulty swallowing painkillers
- if your symptoms are not being well-controlled with tablets or injections.
A nurse will usually change the syringe every 24 hours. Some people have a syringe pump until their symptoms improve. This could be at home or in hospital.
Having a syringe pump does not stop you moving around as usual. You can carry it in a pocket or bag. You can go out shopping or for a meal while wearing the pump.
Pain is often described as being mild, moderate or severe. Different types of painkillers are effective for the different levels of pain.
- Simple, over-the-counter painkillers such as paracetamol and ibuprofen are often used for mild pain.
- Drugs called opioids or ‘morphine-type’ medicines, are usually used to treat mild to moderate pain. This includes drugs such as codeine and tramadol.
- Stronger opioids, such as fentanyl or oxycodone are usually used to treat moderate to severe pain.
We have more information about types of painkillers and ways they are used.
Your doctor or nurse may prescribe other drugs to help control the pain. You may take these with painkillers or on their own. The drugs you have will depend on the type of pain you have. Sometimes it may take some time to find the drug and dose that works best for you.
Your doctor or nurse will discuss your pain management with you. They will tell you which drug is most suitable for you. They will also explain the different side effects and how they may affect you.
Drugs to treat nerve pain
Pain caused by nerve damage can be treated with specific drugs that treat nerve pain. They are taken as tablets or capsules. The dose of the drug may need to be gradually increased. It may take up to a few weeks to feel their full effect. It is important to continue taking the drug your doctor prescribed, even if it does not work immediately.
Some of these drugs work as anti-epilepsy drugs. They change the way in which nerves send messages to your brain. These include:
Other drugs that treat nerve pain can also be used to treat depression. Some people worry about taking them because of this. Research shows that in lower doses they work well in targeting and reducing nerve pain. They include:
Drugs to treat bone pain
People who have pain from cancer that has spread to the bones may be prescribed drugs called bisphosphonates. As well as helping to reduce pain, bisphosphonates also strengthen the affected bones. You have them as a drip into a vein, usually once a month, or as tablets. Commonly used bisphosphonates are:
- sodium clodronate
- ibandronic acid
- disodium pamidronate
- zoledronic acid.
Denosumab is another treatment that can be used to relieve bone pain. You have it as an injection just under the skin, every 4 weeks.
Steroids to reduce swelling
Steroids can reduce swelling and pain caused by a tumour pressing on a part of the body. You usually have steroids as tablets, but they can also be given as an injection. There are different types. People usually have dexamethasone or prednisolone.
Drugs to relax muscles
If muscle spasms make the pain worse, your doctor may prescribe a short course of a drug to relax the muscles.
Commonly used muscle relaxants are:
- baclofen (Lioresal®)
- hyoscine butylbromide (Buscopan®), which relaxes muscles in the bowel and helps tummy cramps.
Below is a sample of the sources used in our cancer pain information. If you would like more information about the sources we use, please contact us at email@example.com
Fallon, Giusti, Aielli et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Annals of Oncology. 2018. 29: 166–191.
O'Brien, Christrup, Drewes, et al. European Pain Federation position paper on appropriate opioid use in chronic pain management. European Journal of Pain. 2017. 21: 3-19.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Viv Lucas, Consultant in Palliative Medicine.
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