Most men who have pain caused by advanced prostate cancer need to take pain-relieving drugs at some stage. There are different types of pain-relieving drugs. Your health professionals may use a guide called a ‘pain relief ladder’ to decide which drugs will help you. The ladder recommends different types of drugs for each level of 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.
By using this approach, your treatment can be moved up to the next stage if your pain is not controlled by one type of drug. Most people find that this helps to control their pain.
You might be offered a combination of drugs, because they work in different ways. And you might take pain-relieving drugs along with other pain-relieving treatments such as radiotherapy. If your pain improves after these treatments, your doctor or nurse may be able to reduce your medication. This shouldn’t be done suddenly and you should always discuss it with your doctor or nurse.
It’s important to take your drugs regularly, as prescribed by your doctor or nurse. This will give you more constant pain control. Don’t put off taking your drugs. If you wait until the pain comes back, you will have a gap where your pain is not properly controlled, and it might get worse. It can then be more difficult to get it under control.
Pain can come on unexpectedly and you might need to try different treatments to see what works. Doctors and nurses need feedback from you to get your pain relief right.
If your pain comes back before your next dose is due, let your doctor or nurse know. The dose might need changing.
You might find your pain doesn’t go away straight away when you take pain-relieving drugs. This is because they can take a while to be absorbed by the body and start working.
All medicines can cause side effects. We describe the most common side effects of pain-relieving drugs below. But you might not get all or any of these. If you do get side effects that won’t settle down, your doctor can change the amount or the type of drugs you take.
For more information about side effects, check the patient information leaflet included with your medicines or speak to your doctor or nurse at the hospital, or your GP.
These are mainly mild pain-relieving drugs. They include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. You can use them together with stronger pain-relieving drugs.
NSAIDs can help reduce inflammation that may be causing your pain. You should only take NSAIDs regularly if they’ve been prescribed for you. This is because taking them for a long time can cause side effects such as stomach irritation, stomach ulcers, kidney problems, and heart problems. You may not be able to take NSAIDs if you already have problems with your stomach, kidneys or heart.
Your doctor or nurse might prescribe medicines to reduce the risk of side effects from NSAIDs. Taking NSAIDs after food will also help to reduce stomach irritation. You should 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.
You might need stronger pain-relieving drugs called opioids. These include strong opioids such as 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 aren’t suitable, some opioids such as fentanyl or buprenorphine are also available as a skin patch.
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 driver. It means the drug stays 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.
Like all medicines, opioids can cause side effects.
- Difficulty emptying your bowels (constipation). Most people get this side effect of opioids, which can be very uncomfortable. Your doctor should give you medicines to make it easier to empty your bowels (laxatives). Drinking plenty of water, eating a high fibre diet and exercising, if possible, might also help to prevent constipation. If it doesn’t get better, speak to your doctor – but don’t stop taking the pain-relieving drugs.
- Sickness. You might feel sick or be sick for the first few days of taking opioids, but this usually improves. If you feel sick, your doctor can prescribe anti-sickness tablets to stop this or give you a different pain-relieving drug if the sickness doesn’t improve.
- Drowsiness. When you first start taking opioids you might feel drowsy or find it hard to concentrate. This usually improves after a few days, as your body gets used to the drug. Ask your doctor or nurse whether it is safe for you to drive when you are taking opioids.
- A dry mouth. Sipping cold water throughout the day can help. You can also try chewing gum or sucking boiled sweets or ice cubes.
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 might not start with the strongest type of opioid, and the dose will be carefully controlled by your doctor. If you’re worried about taking opioids, 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. Which ones you are prescribed will depend on what is causing your pain.
Your doctor might suggest drugs that can also be used to treat other health problems. For example, drugs that can be used to manage epilepsy (such as gabapentin or pregabalin) or depression (such as amitriptyline) can help with nerve pain. If your doctor prescribes anti-depressants or anti-epileptics for your pain, it doesn’t mean they think you are depressed or have epilepsy. Different doses of these drugs are usually needed to treat depression or epilepsy.
A type of cream called capsaicin cream can also be used to help with nerve pain if you find it difficult to take tablets. A pain-numbing skin patch, such as a lidocaine patch, can also be used on painful areas.
Antibiotics can be prescribed if your pain is caused by an infection.
Muscle relaxants (such as diazepam) can also be used if you have muscle spasms. Muscle spasms can be painful or make other pain worse.
Talk to your doctor, nurse, or pharmacist about possible side effects before you start taking any new medicines.
If your cancer has spread to the bones it could cause swelling and press on the nerves in the bone, causing pain. Steroids can help to reduce swelling around the cancer, and so reduce the pain. You might be able to take steroids in combination with pain-relieving drugs and other types of treatment. Lower doses of steroids can also be used to treat the cancer itself.
Like most medicines, steroids can cause side effects. Read more about steroids, including the possible side effects.