Other drugs for pain control

You might have other drugs to take alongside painkillers. These are sometimes called co analgesics or adjuvant analgesics. There are different types.

Your doctor might give you these drugs to help relieve your pain. It might mean that you can take a lower amount (dose) of opioid painkillers than you otherwise would. So you’re less likely to have side effects.

There are different types of drugs including:

• steroids

• anti depressants

• drugs to prevent fits (anti convulsants)

• drugs that stop parts of the body from feeling (anaesthetics)

• muscle relaxants

Steroids

Steroids help control many body functions including helping to reduce swelling. These are useful for pain control because swelling around a tumour increases pressure on surrounding tissues and so may increase pain.

The body makes steroids naturally, but they can also be made artificially and used as drugs. Doctors prescribe steroids for many different reasons and for many different illnesses and conditions.

Steroids come in different forms such as tablets, liquids, creams or as an injection into the vein (intravenous). In cancer care, you are most likely to have steroid drugs called either prednisolone or dexamethasone.

We have detailed information about taking steroids and the possible side effects.

Anti depressants

Some types of anti depressant, when given at a lower dose, can help to relieve nerve pain that other painkillers do not control. At a higher dose they can help with depression that long term chronic pain might cause. An example of an anti depressant is Amitriptyline.

Side effects

Different anti depressants have different side effects. They can cause: 

• a dry mouth

• an increase or decrease in appetite

• changes to your sleep pattern

• drowsiness

The specific effects depend on which drug you take. Ask your doctor or nurse for advice on the specific side effects of your drug.

Anti convulsants

This group of drugs is usually used to control fits (seizures). But they can often help to relieve burning or tingling pain (nerve pain). They are called anti convulsant drugs.

Some anti convulsant drugs used for pain include:

• gabapentin (Neurontin)
• topiramate (Topamax)
• lamotrigine (Lamictal)
• pregabalin (Alzain, Lyrica)

Side effects

Drugs that prevent fits can also have side effects. Depending on the drug, these can include: 

• difficulty sleeping
• tiredness
• dizziness
• loss of appetite
• feeling sick

This is a very general list. Ask your doctor to tell you more about the side effects of the drugs that you’re taking.

Anaesthetics

The use of drugs to stop parts of the body from feeling is called anaesthetics. Doctors can use these in general pain control, as well as in surgery. You have anaesthetics for pain problems in a specific part of the body. 

Injections into the spine

You might have local anaesthetic by injection or infusion into the spine to help relieve severe pain.

This is called an epidural, intrathecal or spinal anaesthetic depending on where in the spine the anaesthetic is placed. This can give very good pain control if other standard painkilling tablets and medicines haven’t worked well.  

To have an epidural, the doctors put a small tube (called a catheter) into your back using a needle. It goes into the area near the spinal cord and the chosen painkiller is continuously injected through the tube into your spine.

This may be the best way to control your pain especially if you’re having a big operation for your cancer. It can control pain for up to 24 hours after your surgery.

This method is not a first choice for treating cancer pain that’s not related to surgery. But it can help some people who find that painkilling tablets or injections are not controlling their pain.

Implanted intrathecal pump

Some people have a small catheter placed into the fluid around the spinal cord. This catheter is then attached to a small pump which sits under the skin just under your waistline. This may be placed under the skin on your back, but it is more usual to have it at the front. These are called implanted intrathecal pumps.

You can be at home with this. Every few weeks you visit a specialist doctor or nurse. They check and refill the pump with the painkiller drugs. They can change the dose, depending on how comfortable you are feeling.

Doctors usually use this treatment where other methods of pain control have not worked.

Both these systems of spinal anaesthetics need highly experienced doctors (anaesthetists) to do the procedure. It also needs a highly trained team to follow you up afterwards. Not all hospitals, hospices or pain clinics can provide these services.

Ketamine

Ketamine is a drug that is usually used as an anaesthetic. But in smaller doses, it can be useful as a painkiller for severe nerve pain (neuropathic). You might have this drug on its own or alongside opioids when other more neuropathic painkillers have not worked as well.

This medicine is managed by your specialist pain doctor or nurse. You have ketamine:

• as a liquid that you swallow OR
• through a needle just under the skin, connected to a continuous infusion pump 

Other anaesthetics

Some local anaesthetic drugs can relieve pain from mouth ulcers. Your doctor might suggest benzydamine (Difflam) mouthwash or spray if you have a painful mouth.

Lidocaine patches (Versatis) are a type of local anaesthetic. You stick the patch on your skin over the area where the pain is. It stays on for 12 hours. Then you take it off for 12 hours.

Medicines for your mouth

There are drugs available to give your mouth a protective covering if it is sore. They include:

• Gelclair

• MuGard

• Caphosol

• Episil

• OraLife gel

You rinse your mouth with these medicines. They form a protective coating over your mouth and throat. This can make eating or swallowing easier.

Muscle relaxants

Muscle relaxants may also be used alongside other drugs to help get your pain controlled. Sometimes muscles can be tighter after surgery, or after certain treatments such as radiotherapy. These drugs might be useful if your muscles go into spasm particularly if you have bladder cancer, or when there is cancer in the spine causing pain.

There are many types, examples of drugs used to relax the muscle are:

• baclofen
• diazepam
• oxybutynin
• hyoscine