Painkillers and cancer
There are different types of painkillers and ways of taking them. Your medical team will find the best painkiller for you.
About cancer and painkillers
Medicines used to treat pain are called analgesics. Analgesics are often called painkillers. This is the term we use on these pages. There are lots of different painkillers. They treat different levels and types of pain.
You may be given other drugs as well as painkillers to help with pain relief. These include drugs to treat bone pain called bisphosphonates. You may also be given steroids to reduce swelling.
Your doctor or nurse will regularly assess your pain to make sure you are taking the right combination of medicines for you. Painkillers are usually prescribed by doctors, but some nurses can also prescribe them.
You may find it helpful to read our information on common asked questions and answers about painkillers.
Taking painkillers regularly
Pain that continues for more than 3 months is often called chronic or persistent pain. If you have chronic pain, you may need to take painkillers regularly to control it.
Always take your painkillers at regular intervals as prescribed. This is important to make sure they work as well as possible. The aim is for pain control to be constant, so you should not be in pain when you take the next dose.
Delaying taking painkillers can make your pain worse. It may then take more time and a higher dose of painkillers to get your pain back under control.
If you have been given painkillers for breakthrough pain, do not wait for the pain to get bad before taking them.
It is important to tell your doctor or nurse if your pain gets worse. Then they can treat it before it becomes harder to control. You may need your painkiller dose adjusted or have a different painkiller. It can sometimes take time to get the right painkiller and dose.
Ways of taking painkillers
There are a number of ways that painkillers can be taken including:
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Tablets and capsules
You usually take painkillers as tablets or capsules. Tell your doctor or nurse if you find these hard to swallow. Many painkillers are available as liquids and some can be dissolved in water.
If you have a feeding tube, you will be able to have some liquid or soluble painkillers through it.
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Skin patches
Some painkillers can be absorbed through the skin. You have these as a patch you put on your skin. This slowly releases a constant amount of painkiller. A patch can be helpful for people who have difficulty swallowing or find it hard to remember to take their painkillers regularly.
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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 between your gum and your cheek (buccal) or under your tongue (sublingual).
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As an injection
You can also have painkillers as an injection under the skin, into a muscle or directly into a vein.
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Suppositories
Some painkillers can be inserted into the back passage (rectum). The drug is absorbed through the lining of the rectum.
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Gels or creams you put on skin
If the pain is in one area (local), rubbing a gel or cream on to 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 also help with 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.
Ask your doctor or nurse for advice first. Do not use any gels or creams on skin that is inflamed or broken. Wash your hands after applying any cream or gel. Always tell your doctor or nurse that you are using them.
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Nasal sprays
Some painkillers can be sprayed into the nose. They are absorbed through the lining of the nose.
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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 given continuously over a set time through a pump. There are different types of pump used for different reasons. A syringe containing the painkiller is placed in the pump and connects through a tube to one of the following ways:
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Under the skin
The tube connects to a fine needle placed under the skin. The pump is called a syringe pump. It can be used to manage cancer-related pain in different situations.
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Into a vein through a pump
The tube connects to a fine needle placed into a vein. This is usually done after surgery for short-term pain control.
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Into a fine tube in the back
The tube connects to a fine plastic tube placed in your back. 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 portable pump that can be used to give different medicines. The pump delivers a continuous dose through a small, thin needle placed just under your skin. You can have other drugs through a syringe pump, such as anti-sickness drugs, as well as painkillers.
A syringe pump may be used if:
- if you are feeling, or being sick
- it is difficult for you to swallow tablets
- your pain is not being well controlled with tablets or injections.
A nurse will usually change the syringe every 24 hours. You can have a syringe pump for as long as you need it. This might 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 wearing the pump.
Types of painkiller
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-like’ medicines, are usually used to treat mild to moderate pain. This includes drugs such as codeine and tramadol.
- Stronger opioids, such as morphine or oxycodone are usually used to treat moderate to severe pain.
We have more information about types of painkillers and ways they are used.
Other drugs used to control pain
Your doctor or nurse may prescribe other drugs to help control pain. You may take these with painkillers or on their own. The drugs your doctor prescribes will depend on the type of pain you have. Sometimes it can 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 will explain the different side effects of any drugs you are prescribed and how they may affect you.
Drugs to treat nerve (neuropathic) pain
Specific drugs are used to treat nerve pain. They are taken as tablets or capsules. It may take a few weeks for them to work. It is important to keep taking the drug your doctor prescribes, even if does not work straight away. The dose of the drug may need to be gradually increased.
Some of these drugs are also used to treat seizures. They change the way in which nerves send messages to your brain. They include:
- gabapentin
- pregabalin
- clonazepam.
Other drugs that treat nerve pain can also be used in higher doses to treat depression. Some people worry about taking them because of this. But research shows that in lower doses they work well in targeting and reducing nerve pain. These drugs include:
- duloxetine
- amitriptyline.
Drugs to treat bone pain
Bisphosphonates
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 or as tablets. Commonly used bisphosphonates are:
- sodium clodronate
- ibandronic acid
- disodium pamidronate
- zoledronic acid.
If you have a bisphosphonate as an injection into a vein, you have treatment once every 4 weeks.
Denosumab
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 are causing pain, your doctor may prescribe a short course of a muscle relaxant such as:
- diazepam
- clonazepam
- baclofen (Lioresal®)
- hyoscine butylbromide (Buscopan®), which relaxes muscles in the bowel and helps treat tummy cramps.
Related pages
About our information
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References
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 cancerinformationteam@macmillan.org.uk
Fallon M, Giusti R, Aielli F, et al. Management of Cancer Pain in Adult Patients: ESMO Clinical Practice Guidelines, Annals of Oncology, 2018; 29 (Suppl 4): 166–191. Available from: www.esmo.org/guidelines/guidelines-by-topic/supportive-and-palliative-care/cancer-pain (accessed Jan 2022)
Pain and symptom control guidelines for adults; Greater Manchester and Eastern Cheshire Strategic Clinical Networks 2019. Available from: www.england.nhs.uk/north‑west/wp‑content/uploads/sites/48/2020/01/Palliative‑Care‑Pain‑and‑Symptom‑Control‑Guidelines.pdf (accessed Jan 2022)
Palliative cancer care – pain. National Institute for Health and Care Excellence March 2021. Available from: cks.nice.org.uk/topics/palliative‑cancer‑care‑pain (accessed Jan 2022)
Scottish Palliative Care Guidelines. Available from: www.palliativecareguidelines.scot.nhs.uk (accessed Jan 2022)
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical professionals and people living with cancer. It has been approved by our Senior Medical Editor, Dr Ollie Minton, Macmillan Consultant in Palliative Medicine.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
Date reviewed
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