Cancer Pain : Medicines Used, Part 2

by National Cancer Institute

(Page 4 of 8)

Nonopioids

Nonopioids control mild to moderate pain. Some can be bought without a prescription. For detailed information on nonopioids, review the chart below.

Brand-Name Drugs Versus Generic Drugs

Drugs may have as many as three different names: brand, generic, and chemical. Drug companies give their products brand names. The U.S. Food and Drug Administration (FDA) approves the generic, shortened names by which drugs are usually known. Chemical names are long and tend to be hard to pronounce. Here's an example:

• Brand name: Tylenol
• Generic name: Acetaminophen
• Chemical name: N-(4-hydroxyphenyl) acetamide

Many pain relievers are available under both generic and brand names. Your doctor, nurse, or pharmacist can tell you the generic name.

Generic products are generally less costly than brand-name drugs. Sometimes medicines can have the same generic name, but are produced by different companies. Because the companies may produce the medicines differently, they may differ in the way they are absorbed by the body. For this reason, your doctor may prefer that you take a brand-name drug. You might want to ask your doctor, nurse, or pharmacist if you can use a less expensive medication. Pharmacists are careful to obtain high-quality generic products, so it is sometimes possible to make substitutions.

In addition to the main substance (aspirin, acetaminophen, or ibuprofen), some brands contain substances called additives. Common additives include:

• Buffers (e.g., magnesium carbonate, aluminum hydroxide) to decrease stomach upset.
• Caffeine to act as a stimulant and lessen pain.
• Antihistamines (e.g., diphenhydramine, pyrilamine) to help you relax or sleep.

Medicines with additives can cause some unwanted effects. For example, antihistamines sometimes cause drowsiness. This may be fine at bedtime, but it could be a problem during the day or while you are driving. Also, additives tend to increase the cost of nonprescription pain relievers. They can also change the action of other medicines you may be taking.

Plain aspirin, acetaminophen, or ibuprofen probably work as well as the same medicines with additives. But if you find that a brand with certain additives is a better pain reliever, ask your doctor, nurse, or pharmacist if the additives are safe for you. Talk with them about any concerns you may have about the drugs contained in your nonprescription pain medicines.

NSAIDs

Before you take aspirin, acetaminophen, or other nonopioids in any form, ask your doctor or nurse if there is any reason for you not to take it and how long you can take it.

NSAIDs are similar to aspirin. Either alone or in combination with other medicines, NSAIDs are useful in controlling pain and inflammation.

Precautions When Taking NSAIDs

Some people have conditions that may be made worse by NSAIDs or by any product that contains NSAIDs. In general, NSAIDs should be avoided by people who:

• Are allergic to aspirin.
• Are on chemotherapy (anticancer drugs).
• Are on steroid medicines.
• Have stomach ulcers or a history of ulcers, gout, or bleeding disorders.
• Are taking prescription medicines for arthritis.
• Are taking oral medicine for diabetes or gout.
• Have kidney problems.
• Will have surgery within a week.
• Are taking blood-thinning medicine.

Be careful about mixing NSAIDs with alcohol -- taking NSAIDs and drinking alcohol can cause stomach upset and sometimes bleeding in the lining of the stomach.

"Hidden Aspirin"

Some opioid medications also contain aspirin. If your doctor does not want you to take aspirin, be sure to read the labels carefully. If you are not sure if a medicine contains aspirin, ask your pharmacist.

Side Effects of NSAIDs

The most common side effect from NSAIDs is stomach upset or indigestion, especially in older patients. Taking NSAIDs with food or milk or immediately following a meal lessens the chance of this occurring. Ask your pharmacist to tell you which NSAIDs products are less likely to upset your stomach.

NSAIDs also prevent platelets - blood cells that help blood clot after an injury - from working correctly. When platelets don't function as they should, bleeding is more difficult to stop.

NSAIDs can also irritate the stomach and cause bleeding. If your stools become darker than normal or if you notice unusual bruising - both signs of bleeding - tell your doctor or nurse. Other side effects include kidney problems and stomach ulcers.

Acetaminophen

This medicine relieves pain in a way similar to NSAIDs, but it does not reduce inflammation as well as NSAIDs. People rarely have any side effects from the usual dose of acetaminophen. However, liver and kidney damage may result from using large doses of this medicine every day for a long time or drinking alcohol with the usual dose. Moderate amounts of alcohol can produce liver damage in people taking acetaminophen.

Your doctor may not want you to take acetaminophen regularly if you are receiving chemotherapy. It can cover up a fever. The doctor needs to know about any fever because it may be a sign of infection, which needs to be treated.

Opioids

These medicines are used alone or with nonopioids to treat moderate to severe pain. Opioids are similar to natural substances (endorphins) produced by the body to control pain. Some work better than others in relieving severe pain. These medicines were once made from the opium poppy, but today many are synthetic, that is, they are chemicals made by drug companies. See the table below for examples of opioids.

What Is Drug Tolerance?

People who take opioids for pain sometimes find that over time they need to take larger doses. This may be due to an increase in the pain or the development of drug tolerance. Drug tolerance occurs when your body gets used to the medicine you are taking, and your medicine does not relieve the pain as well as it once did. Many people do not develop a tolerance to opioids. If tolerance does develop, usually small increases in the dose or a change in the kind of medicine will help relieve the pain.

Increasing the doses of opioids to relieve increasing pain or to overcome drug tolerance does NOT lead to addiction.

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