Understanding Cancer Pain
Using pain medicines
Medicines that relieve pain are called analgesics, also known as pain medicines or pain relievers. Some people also use the term painkiller, but it is not accurate to say that medicines can kill pain. Analgesics do not affect the cause of the pain, but they can help reduce pain. Different types of medicine may be used, depending on the type and level of pain. Your health care team will compare the expected pain relief against possible side effects and how the side effects might affect your quality of life. Let them know what you’d like to be able to do, e.g. “I like to be awake throughout the day”.
Types of pain control
There are different types of pain medicines.
- Examples include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).
- Often available over the counter without a prescription.
- Paracetamol is used to help with bone pain, muscle pain, pain in the skin or in the lining of the mouth.
- NSAIDs are used to reduce inflammation or swelling.
- There are different types of opioids depending on the type of pain. Opioids need a prescription.
- Examples include oxycodone, morphine and fentanyl.
- Can help control some types of pain.
- Often used with non-opioid and opioid medicines.
Give your medicines time to work
Different pain medicines take different amounts of time to work. How long each one takes depends on whether the ingredient that makes the medicine work, known as the active ingredient, is released slowly or immediately.
Slow release medicines – Also known as sustained release medicines, these release the active ingredient continuously to provide pain control over a longer period of time, often for 12–24 hours. Slow release medicines are used for constant pain and need to be taken as prescribed. This helps keep the amount of medicine in the blood high enough to work well.
Immediate release medicines – These release the active ingredient fast, usually in less than 30 minutes. Immediate release medicines are used for occasional, temporary pain (breakthrough pain) because they work quickly but for a short period of time, often for 4–6 hours.
How quickly different medicines relieve pain also varies greatly from person to person. It depends on how much medicine you take (the dose) and how often you take it (the frequency).
Take your medicines regularly
Pain medicines need to be taken as prescribed to control pain. This helps maintain a steady level of medicine in the body. Some people call this “staying on top of the pain”.
By taking your pain medicine regularly, even if you are not in pain, your pain may come back as mild rather than strong pain. It is important to use the correct pain medicine at the right time for it to work.
Understand the different ways to manage pain
To manage your pain, your health care team may recommend a combination of prescription and non-prescription medicines. You may also consider trying complementary therapies.
Prescription medicines – These are medicines that your doctor must authorise you to take and only a pharmacist can give you (dispense). Most prescription medicines have two names:
- generic name – this identifies the chemical compounds in the drug that make it work
- brand name – this is created by the pharmaceutical company that made the medicine.
The generic name will be on the prescription, but the brand name may appear on the box. A medicine may have more than one brand name if it’s produced by different companies.
Non-prescription medicines – These are available without a prescription, and can be bought from pharmacies and supermarkets. They include over-the-counter medicines such as mild pain medicines and cold medicines. Vitamin supplements and herbal remedies are also considered non-prescription medicines.
Allied health services – These offer therapies, such as physiotherapy, exercises, special equipment and psychological therapies, to help people manage their pain and stay comfortable.
Complementary therapies – These are therapies that can be used alongside conventional medical treatments to improve your quality of life and wellbeing.
Ways of taking medicines
Pain medicines are taken in several ways, depending on the type of medicine and the form that it is available in.
tablet or capsule – This is the most common form of pain medicine. It is usually swallowed with water.
liquid – This may be an option if you have trouble swallowing tablets or for convenience.
injection – A needle is inserted into a vein (intravenously), into a muscle (intramuscularly) or under the skin (subcutaneously).
skin patch – This is stuck on your skin and gradually releases medicine into the body. Patches vary in how often they need to be changed, which may be daily, every few days or weekly – check your prescription.
intravenous infusion – Medicine is slowly injected into a vein over many hours or days using a small plastic tube and pump. If a device is attached to the infusion, you press a button to release a set dose of medicine when you need it. This is called patient-controlled analgesia (PCA).
subcutaneous infusion (pump) – Medicine is slowly injected under the skin using a small plastic tube and portable pump. This can be given over many hours or days.
sublingual tablet – This is put under the tongue and dissolves without chewing or sucking.
intrathecal injection or infusion – Liquid medicine is delivered into the fluid surrounding the spinal cord. This is commonly used to treat the most severe cancer pain.
suppository – A small pellet is put into the bottom (rectum). The pellet breaks down and the medicine is absorbed by the body. A suppository may be suitable if you have nausea or trouble swallowing.
Keep track of medicines
There are different ways to remember all the medicines you are taking and help ensure you take the correct dose of medicine at the right time. You can share this information with the people involved in your care.
Medicine packs – You can ask your pharmacist to organise your tablets and capsules into a blister pack (e.g. Webster-pak), which sets out all the doses that need to be taken throughout the week, along with a description of each drug.
Medicines list – This keeps all the information about your medicines together. You can record what you need to take, what each medicine is for, when to take it, and how much to take. You can:
- create your own list on paper or online
- order a printed NPS MedicineWise list to keep in your wallet or handbag
- download the MedicineWise app from the Apple Store or Google Play onto your smartphone. You can scan the barcode on packaging to add a medicine to the app and set up alarms for taking the medicine.
Discuss your pain medicines with family and friends
Family members, carers and friends sometimes have opinions about the pain relief you’re having. Your family members may feel anxious about you using pain medicines such as opioids. This may be because they are worried that you will become addicted.
Let your family know how pain affects what you can do and how you feel, and that keeping the pain under control allows you to remain comfortable and enjoy your time with them. You may want to ask your health care team if they can explain to your family and carers why a particular medicine has been recommended for you.
All medicines may have side effects, particularly if they are not taken as directed or taken for too long. Taking some medicines for too long can make pain worse.
Using different medicines together
Some medicines can react with each other, and this can change how well they work or cause side effects. Let your doctor, nurse or pharmacist know if you’re taking any other medicines at the same time as your pain relief. This includes all prescription and non-prescription medicines, vitamins, herbs and other supplements.
Many cold and flu pills and other over-the-counter medicines contain paracetamol or anti-inflammatories. These ingredients count towards your total daily dose, and you may need to take a lower dose of the pain medicine. Medicines for colds, menstrual (period) pain, headaches, and joint or
muscle aches often contain a mixture of drugs, including aspirin. People receiving chemotherapy should check with their oncologist before taking aspirin as it increases the risk of internal bleeding. Aspirin may also cause minor cuts to bleed a lot and take longer to stop bleeding.
Over-the-counter medicines for allergies may cause drowsiness, as can some pain medicines. Taking them together can make it dangerous to drive and to operate machinery.
The Therapeutic Goods Administration (TGA) collects information about medicines and medical devices that haven’t worked well. You can search the events at their Database of Adverse Event Notifications (DAEN).
Tips for using pain medicines safely
- Ask your doctor or pharmacist for written information about your pain medicines: what they are for; when and how to take them; possible side effects and how to manage them; and possible interactions with other medicines, vitamins or herbal supplements or remedies.
- Take only the prescribed dose. Do not stop taking a medicine or change the dose without talking to your doctor.
- Keep medicines in their original packaging or ask your pharmacist to put the medicines into a labelled blister pack to avoid dangerous mix-ups.
- Store medicines in a safe place that is out of reach of children.
- Write a note or set an alarm on your smartphone to remind yourself when to take your medicines.
- Ask your GP whether a pharmacist could check what medicines you’re taking and that you’re taking them correctly. This is known as a home medicines review.
- Check the expiry dates of medicines. If they are near or past their expiry, see your doctor for a new prescription.
- Take out-of-date medicines or any that you no longer need to the pharmacy for safe disposal.
- Ask your doctor or pharmacist what activities are safe (e.g. driving, using machinery) when taking pain medicines.
- Call the Medicines Line on 1300 633 424 for information on medicines.
- Let your health care team know of any side effects. Call the Adverse Medicine Events Line on 1300 134 237 if you suspect you’ve had a reaction to any kind of medicine. If you need urgent assistance, call Triple Zero (000) or go to a hospital emergency department.
You can take prescription and non-prescription medicines overseas if they’re for your personal use. A reasonable amount of medicine and medical equipment is allowed under powder, liquid, aerosol and gel restrictions.
Ways to prepare for travelling with medicines include:
- Ask your doctor if you need to change your medicine schedule to allow for time differences and if there are limits on the amount of medicines you can take overseas.
- Check with the consulates or embassies of the countries you’re visiting to make sure your medicine is legal there and if there are restrictions on how much medicine you can take with you.
- Put any medicines you need during the flight (include a few extra doses in case you are delayed) in your carry-on baggage ready for screening at the airport; pack the rest of your medicines in your checked baggage.
- Carry a letter from your doctor listing each medicine, how much you’ll be taking, and any equipment you need such as hypodermic needles or gel packs, and stating that the medicine is for your personal use.
- Keep medicines in their original packaging, which includes the label with your name, so they can be easily identified, and make sure the name on the medicines matches the name on the passport. Call the Travelling with PBS Medicines Enquiry Line on 1800 500 147 for more information.
This information is reviewed by
This information was last reviewed August 2021 by the following expert content reviewers: Dr Tim Hucker, Pain Medicine Specialist, Peter MacCallum Cancer Centre, VIC; Dr Keiron Bradley, Palliative Care Consultant, Bethesda Health Care, WA; A/Prof Anne Burke, Co-Director Psychology, Central Adelaide Local Health Network, President, Australian Pain Society, Statewide Chronic Pain Clinical Network, SA, School of Psychology, The University of Adelaide, SA; Tumelo Dube, Accredited Pain Physiotherapist, Michael J Cousins Pain Management and Research Centre, Royal North Shore Hospital, NSW; Prof Paul Glare, Chair in Pain Medicine, Palliative Medicine Specialist, Pain Management Research Institute, The University of Sydney, NSW; Andrew Greig, Consumer; Annette Lindley, Consumer; Prof Melanie Lovell, Palliative Care Specialist HammondCare, Sydney Medical School and The University of Technology Sydney, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Melanie Proper, Pain Management Specialist Nurse Practitioner, Royal Brisbane and Women’s Hospital, QLD; Dr Alison White, Palliative Medicine Specialist and Director of Hospice and Palliative Care Services, St John of God Health Care, WA.