Different types of pain medication exist for different types of pain. Pain can also be acute (short-term) or persistent (chronic or long-term). Generally, depending on your type of pain, a combination of medication is prescribed.
TYPES OF PAIN MEDICATION
There are several broad classes of pain medication available. These are:
- Over-the-counter medication
- Neuropathic agents
These medications may already be known to you. These are generally prescribed for mild to moderate pain. When prescribed together with stronger pain killers, they work synergistically to manage pain.
Examples of over-the-counter medication include:
- Paracetamol (brand names include Panadol)
- NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (brand names include Nurofen, Advil), diclofenac (brand names include Voltaren) and celecoxib (brand names include Celebrex)
Opioids are commonly used in both post-operative acute pain and more persistent cancer pain. These are strong pain killers, and are complex medications with both short-term and long-term side effects. It is important to use these medications safely. The appropriateness as well as the risks and benefits of these medications would be guided by your medical practitioner or pain specialist.
Examples of opioids include:
- Morphine (brand names include Ordine, Sevredol)
- Oxycodone (brand names include Endone, Oxynorm)
- Buprenorphine (brand names include Norspan)
- Tapentadol (brand names include Palexia)
Common side effects include:
- Nausea and vomiting
- Dry mouth
- Physical dependence and withdrawals
- Breathing issues
Post-surgical pain can be severe and affect your mobility, sleep, deep breathing and coughing abilities and rehabilitation. Therefore, it is important to get this managed well. When you are in hospital, the nursing staff will give you these medications as prescribed. It is important that you speak with your nurse when you need pain relief and if you feel like the pain medication is not working for you.
After discharge from hospital
Opioids are generally intended for short-term use.
When you are discharged from hospital, you may be prescribed a limited amount to take at home. If you require ongoing use of opioids, you will need to contact your GP for further prescriptions and management.
As opioids are regulated medications, there are restrictions on prescriptions of these medications. Your GP should be the main prescribing doctor for ongoing opioid prescriptions. Ensuring there is a single prescriber is recommended as there are monitoring rules and regulations to the prescription and supply of opioids. There are also limits to the amount of opioids that can be prescribed. This is normally 2 weeks, but a larger supply may be given if there are indications such as in palliative care and those who have a stable dose.
Weaning off opioids
For some patients, opioid medications need to be weaned. For patients using moderate to high doses and those who have been on opioids for a long period of time, generally months, it is necessary to reduce the dose gradually to prevent unwanted withdrawal symptoms such as an increase in pain, sweats, and shakes. These are usually self-limiting and there are medications that can be given to reduce their effects. A reduction in opioids should involve a discussion with your doctor. There is no set reduction plan, but a reduction by 25% every week could be suggested.
Common questions about opioids
- Can I drive whilst on opioids?
Generally, patients can drive when they are on opioids, but we would always advise against doing so if they are at risk to themselves or others, which arises when they are affected by side effects of opioids. This also applies to operating heavy machinery.
- Will I become addicted to opioids?
Anyone who takes opioids can become addicted to them, however, addiction is unlikely if the medication is taken only as directed to relieve acute or persistent pain. Some patients may develop a dependence on opioids, meaning they might need higher doses of the medication to relieve their pain. Only take what is prescribed for you by your doctor and talk to your doctor about any history of addiction (including family history) or concerns you may have.
- Can I overdose on opioids?
When used as prescribed, opioids are quite safe. However, they can be dangerous at higher doses and they can interact with other medications, thereby causing more severe side effects. Ensure your doctor knows everything you are taking (including over-the-counter medication, vitamins and natural medicines) and only take opioids as they are prescribed for you.
The Opioid Medication Fact Sheet summarises the information above.
Neuropathic agents are commonly used to target neuropathic or nerve-related pain. Neuropathic pain commonly arises from problems with the nerves, such as damaged or irritated nerves, or problems with the nerves' ability to transmit pain messages to the brain.
Neuropathic pain can result from the cancer itself, or from treatment such as chemotherapy, radiotherapy and surgery. As nerves are notoriously slow to heal, nerve damage from previous surgeries or other treatments can also contribute to neuropathic pain.
Neuropathic pain is complex. Sometimes, the pain may be unexplained even after conducting an examination and investigations. The management of neuropathic pain can be challenging as it may be a long-term pain and traditional pain relievers may not be effective.
Common descriptors for neuropathic pain include burning, tingling, electric shocks or pins-and-needles. The pain can be in one area or described as “shooting” pain down the arm or leg. It could also be numbness or tingling in the fingers or toes, which could lead to decreased function in the hands or feet.
Examples of neuropathic agents include:
- Pregabalin (brand names include Lyrica)
- Gabapentin (brand names include Gabacor, Neurotin)
- Amitriptyline (brand names include Endep, Entrip)
- Duloxetine (brand names include Duloxecor, Cymbalta)
You may recognise these medications from their other uses. Pregabalin and Gabapentin are also classed as anti-epileptic medications; Amitriptyline and Duloxetine are also classed as anti-depressant medications. Whilst these drugs fall in these other categories, they have been proven to be beneficial in the treatment of neuropathic pain.
Common side effects include:
- Dry mouth
- Feet swelling
- Heart palpitations
Local anaesthetics are related to neuropathic agents as they target similar types of pain. They are a group of drugs that work by numbing the area of your skin that is painful. The type of pain that may be reduced by applying a local anaesthetic is pain that is characterised by a burning, shooting, stinging, or tingling sensation. The particular area of skin may also have an increased sensitivity to touch, heat and/or cold.
Local anaesthetics are usually prescribed topically, to be applied on the skin either as a gel, cream, spray or patch.
The most common example of a local anaesthetic is Lignocaine (also known as Lidocaine). Brand names include Xylocaine, Nervoderm, and Versatis.
Lignocaine is available in various preparations, but is commonly prescribed in the form of a patch, which you can read more about in the Lignocaine Patch Fact Sheet.
Living with neuropathic pain
Neuropathic agents are intended for medium-term to long-term use. If you have been prescribed them in hospital, or in outpatient clinic, your pain specialist or your GP will continue to manage the dose of the medication.
Important goals of treatment for neuropathic pain include maintaining function and quality of life. To help achieve these goals, you may be referred to a physiotherapist, occupational therapist or a psychologist. The multi-disciplinary approach (with input from allied health as well as the medical team) is intended to help achieve the best outcome for you.
Please refer to the Pain Management Strategies page to learn more.
There are other classes of medication that are sometimes used in the management of pain.
Ketamine infusion therapy
Ketamine is a complex medication that is commonly used in both post-operative acute pain and more persistent cancer pain. It is a strong pain-relieving medication that works by targeting pain-sensing nerves, interrupting their pain signals to the brain. When given continuously via an intravenous infusion, it resets these pain signals altogether, which means that there are longer lasting benefits even after the infusion is stopped.
Read more about ketamine infusion therapy in the Ketamine Infusion Fact Sheet.