Treatments for pain in advanced prostate cancer

There are different ways to treat pain. The best treatment for you depends on what’s causing the pain, as well as your overall health, mood, and daily activities.

Because pain can affect many parts of your life, you may need more than one type of treatment to help manage it.

As well as treatments, there are things you can do yourself that might help with your pain. 

Pain-relieving drugs

Most men whose advanced prostate cancer causes them pain, need to take pain-relieving drugs at some stage.

There are different types of pain-relieving drugs. Health professionals may use a guide called a ‘pain relief ladder’ to decide which drugs will help you.

The ladder (see below) recommends different types of drugs for each level of pain. By using this approach, your treatment can be moved up to the next stage if your pain isn't controlled by one type of drug. Most people find that this helps to control their pain.

Pain relief ladder

• Step 1: for mild pain use mild pain-relieving drugs (paracetamol or non-steroidal anti-inflammatory drugs), with or without other treatment.

• Step 2: for moderate pain use weak opioids such as codeine, with or without mild pain-relieving drugs and other treatment.

• Step 3: for severe pain use strong opioids such as morphine, with or without mild pain-relieving drugs and other treatment.

You might be offered a combination of drugs. You may also take pain-relieving drugs along with other pain-relieving treatments, such as radiotherapy.

If your pain improves, your doctor or nurse may lower your medication. This shouldn’t be done suddenly, and you should always talk to your doctor or nurse first.

Taking pain-relieving drugs 

It’s important to take your drugs regularly, as prescribed by your doctor or nurse. This helps keep your pain under control.

Don’t wait until the pain comes back, as it might get worse and be harder to control. If your pain comes back before your next dose is due, let your doctor or nurse know, as the dose might need changing.

Types of pain-relieving drugs

Non-opioid drugs

These are mainly mild pain-relieving drugs. They include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen tablets or gel and naproxen. NSAIDs can help reduce inflammation which may be causing your pain.

These types of drugs are available to buy over the counter from a pharmacy. You can usually use them together with stronger pain-relieving drugs.

Always check with a pharmacist or other health professional before taking new drugs, to make sure they’re suitable for you and safe to take with other medication.

Side effects

You should only take NSAIDs regularly if they’ve been prescribed for you. Taking them for a long time can cause side effects, such as:

• stomach irritation

• stomach ulcers

• kidney problems

• heart problems.

You may not be able to take NSAIDs if you already have problems with your stomach, kidneys or heart.

You may be prescribed medicines to reduce the risk of side effects. Taking NSAIDs after food will also help to reduce stomach irritation. You should also avoid smoking and drinking large amounts of alcohol, as these can increase the risk of stomach ulcers. Your doctor or nurse can give you more information about this.

Opioid drugs

You might need stronger pain-relieving drugs called opioids. These include strong opioids like morphine and weaker opioids such as codeine and tramadol.

You can take opioids in tablet and liquid form. You may be able to take slow-release opioids so that you don’t have to take them so often. If these are not suitable, some opioids such as fentanyl or buprenorphine are also available as a skin patch.

Some opioid drugs can’t be taken at the same time as other pain medication, so it’s important to tell your medical team or pharmacist about any medication you are taking. 

If you find it hard to swallow tablets or liquids, your doctor or nurse might suggest a continuous dose of opioids through a needle under the skin. This uses a small machine called a syringe pump or syringe drive to keep the drug at a constant level in your body so it doesn't wear off. Syringe pumps can be used in hospital or in your home.

It’s possible to get sudden pain even if you’re already taking pain-relieving drugs. This is called breakthrough pain. If you experience this, your doctor or nurse may suggest a fast-acting opioid to help reduce the pain quickly.

Side effects

Like all medicines, opioids can cause side effects.

• Difficulty emptying your bowels (constipation)

• Sickness

• Drowsiness

• A dry mouth

Some men worry about becoming addicted to stronger opioids such as morphine, but if you’re taking morphine to relieve pain it’s unlikely you’ll become addicted.

You won't start with the strongest type of opioid, and the dose will be carefully controlled by your doctor. If you’re worried, speak to your doctor or nurse.

Other drugs for relieving pain

There are other types of drugs that can also be used to help treat pain. These will be prescribed depending on what's causing your pain. Your doctor might suggest drugs that are also used to treat other health problems. 

Other drugs used to treat you pain may include:

• gabapentin or pregabalin (also used to treat epilepsy)

• amitriptyline (also used to treat depression)

• diazepam (a muscle relaxant used to treat painful muscle spasms)

• antibiotics (if your pain is caused by an infection)

• capsaicin cream or lidocaine pain-numbing skin patch (can be used if you find it difficult to take tablets).

• steroids (can help to reduce swelling around the cancer reducing pain. You might be able to take steroids in combination with pain-relieving drugs and other types of treatment). 

Talk to your doctor, nurse, or pharmacist about possible side effects before you start taking any new medicines.

Other treatments to manage pain

Pain-relieving radiotherapy 

Pain-relieving radiotherapy can shrink the cancer cells in the bones and stop them pressing on nerves and causing pain. It can also sometimes slow the growth of cancer cells, giving your bones time to repair and strengthen.

Most men who have pain-relieving radiotherapy find that it helps control their pain. If your pain comes back, you may be able to have more radiotherapy to the same area. This will depend on the dose you've already had and when you had it. Your doctor or nurse will be able to advise on this.

Read more about radiotherapy for advanced prostate cancer and its side effects.

Bisphosphonates

Bisphosphonates, such as zoledronic acid (Zometa^®), are drugs that can help strengthen bones that have become weak or thin. 

Bisphosphonates can strengthen the bones and slow down further bone damage. This can help relieve pain and lower the risk of broken bones and other bone problems.

They are sometimes used if other treatments, such as pain-relieving drugs and radiotherapy, are not controlling your pain. You may be offered another drug called denosumab instead of bisphosphonates.

Read more about bisphosphonates and their side effects.

Surgery to support damaged bone

If there is an area of bone that has been badly damaged by cancer, surgery might be an option, although this isn't very common.

A metal pin or plate can be inserted into the bone under general anaesthetic to strengthen and stabilise the area of affected bone and reduce the risk of it breaking. Or, a type of cement can be used to fill the damaged area. This makes the bone stronger and less painful.

You might have radiotherapy after the operation to help prevent the cancer growing back in that area.

Transcutaneous electrical nerve stimulation (TENS)

Some NHS pain clinics and hospitals offer TENS to help manage pain. You can also buy a TENS machine yourself online or from a pharmacy.

TENS uses a machine to send small electrical currents to nerves in your body through pads placed on your skin. Doctors think that the currents may block the pain signals caused by the cancer. Small studies have found that TENS could help some people with bone pain. However, we need more research before we can say for certain whether TENS can help. 

As the TENS machine is small enough to fit in your pocket, it can be carried around with you so you don’t need to stay in hospital.

Nerve block

This is an injection which changes what you feel in a particular part of the body. It can reduce pain in a specific area. 

Nerve blocks may be an option for men who only have pain in one or two areas, as well as those who can't have, or aren't responding to, other treatments. They aren't widely used and aren't available in every treatment centre. 

Questions to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have, to take to your next appointment.

• What is causing my pain?
• Do I need to see a pain specialist?
• Are there pain-relieving drugs that might help?
• What are the side effects of pain-relieving drugs?
• What other treatments can I have to help manage my pain?
• What else can I do to help with my pain?
• Who should I contact if my pain gets worse?
• Who should I contact at night or at weekends (out of hours)?

References and reviewers

Updated: March 2026 | Due for Review: March 2029