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Pain relief and common side effects

If you have a terminal illness you may experience mild to severe pain. There are a range of different medicines, either aimed specifically at relieving pain, or with other properties as well as pain relief. Most pain can be controlled.

On this page:

Common types of pain medication

Below are some medications used for pain relief. Some can be given at home while others can only be given in a hospital or hospice by a medical professional.

Sometimes medications may be combined, for example, codeine and paracetamol might be used together to provide the right kind of pain relief. Radiotherapy is sometimes used to treat bone pain, for those fit enough to have it.

Medication type and example names What the medication is for and how it works
Non-opioid analgesics
  • Paracetamol
  • NSAIDs (non-steroidal anti-inflammatory drugs) like aspirin, naproxen, ibuprofen (Nurofen®, Brufen®) 
  • Initially, if the pain isn’t too intense, you can use these analgesics. They are all available on prescription or over the counter.
  • Sometimes paracetamol is combined with aspirin, according to your needs and type of pain.
  • NSAIDs are also used to relieve bone pain.

Weak opioids

  • Codeine
  • Dihydrocodeine (DF118 Forte®)
  • Tramadol hydrochloride (Zydol®, Tramacet®)
  • These provide the next level of pain control, as they are stronger than paracetamol.
Strong opioids
  • Morphine
  • Diamorphine
  • Methadone
  • Oxycodone (OxyNorm® and OxyContin®)
  • Buprenorphine (Transtec® patches, BuTrans® patches, Temgesic®)
  • Fentanyl (Durogesic®, Mezolar patches®)
  • These are safe and effective pain killers.
  • Morphine can be given as tablets or as a liquid by mouth. If you often feel sick or vomit, it’s more likely to be given as an injection through a syringe driver. This enables a steady flow of the drug to be absorbed into the blood stream.
  • Sometimes more than one type of painkiller is prescribed. For example, long acting drugs are used to managed underlying (background) pain and short acting drugs are used for breakthrough pain.

Other types of pain medication

Medication type and example names What the medication is for and how it works

Anti-convulsant or anti-seizure drugs

  • Sodium valproate (Epilim®, Episenta®)
  • Gabapentin (Neurontin®)
  • Pregabalin (Lyrica®)
  • These may be prescribed to relieve nerve (neuropathic) pain.

 

Anti-spasmodic
  • Hyoscine butylbromide (Buscopan®)
  • Hyoscine hydrobromide
  • Mebeverine (Colofac®)
  • These can control colicky and crampy pains in the bowel.
  • They work by relaxing the bowel. They’re not usually given if the bowel is obstructed. Your doctor can give you more information about this.
Anti-depressant medications
  • Amitriptyline
  • Nortriptyline
  • Duloxetine
  • These act on nerve pain and are often used for pain relief, even if the person isn’t depressed.
Stress relieving drugs
  • Midazolam (Hypnovel®)
  • Diazepam
  • Lorazepam
  • These can help with agitation.
Steroids
  • Dexamethasone
  • Prednisone
  • These may be prescribed to reduce swellings that are causing pain, for example, a headache due to a brain tumour, and pain caused by pressure around nerves.
  • They may also be used to strengthen the effects of anti-emetic (anti-sickness) drugs.
Bisphosphonates
  • Disodium pamidronate (Aredia®)
  • Ibandronic acid or ibandronate Bondronat®)
  • Sodium clodronate (Bonefos®, Clasteon®, Loron®)
  • Zoledronic acid or zoledronate (Zometa®)
  • These work on the tissue of the bone to relieve bone pain.

Anaesthetics

  • Ketamine (Ketalar®)
  • Taken in low doses, ketamine can relieve neurological or nerve pain by blocking specific pain receptors. It’s not commonly used.
Spinal anaesthetics and nerve blocks
 
  • Spinal anaesthetics are injected into the fluid around the spinal cord.
  • Nerve blocks are procedures where nerves are injected with painkillers to modify and block pain.
  • Both of these treatments are generally provided in hospital.

Side effects of medication

Tell your healthcare assistant, doctor, district nurse or Marie Curie Nurse if you have any change in symptoms after taking a new drug.

If the symptoms are severe, you might need different medication.

Steroids

These can cause:

  • increased appetite, leading to weight gain
  • difficulty sleeping
  • indigestion

Anti-inflammatory drugs

These can cause irritation of the stomach or bowel, ulcers and bleeding from the stomach. Medication can be prescribed to protect the stomach lining.

Anti-spasmodics

Hyoscine butylbromide (Buscopan®) can cause a dry mouth.

Bisphosphonates

This group of medications can cause:

  • headache
  • sickness
  • diarrhoea
  • a flu-like reaction within 48 hours of taking a dose

Opioids

It’s helpful to be aware of the side effects of strong painkillers like morphine. These can include:

  • Constipation – this is the most common side effect of morphine and can be eased by laxatives (which help someone go to the toilet).
  • Nausea and vomiting – anti-emetic (anti-sickness) medication can be prescribed.
  • Depressed breathing – if breathing is laboured and slow, it might be necessary to reduce the dose of morphine gradually. This is very unusual if morphine has been prescribed correctly. Speak to your doctor or nurse urgently about this because you may also be given an antidote to morphine called naloxone, which works very quickly.
  • Drowsiness and sleepiness – if someone is so tired that they can barely communicate, the dose may need to be lowered.
  • Jerking – these motions may be the result of too high a dose of morphine.

Always tell the healthcare assistant, nurse or doctor about these problems, and ask for changes to be made to medication.

Drug-free pain relief

TENS machines 

TENS (transcutaneous electrical nerve stimulation) machines are small devices that are attached to the body with electrodes placed wherever the pain is felt. They deliver gentle electric pulsing to the area, which can tingle, but isn’t painful. These electrical pulses can help relieve pain. The machine is easy to use and you can try it at home.

Acupuncture

Acupuncture is widely used to relieve pain, particularly in pain clinics within hospitals. It is safe and effective in treating chronic pain. It may be available in hospices, in your local hospital, occasionally through your GP practice, or through a private practitioner. Contact the British Acupuncture Council   for more information

Holistic care

It’s natural for people with a terminal illness to feel emotionally or spiritually distressed, whether they’re religious or not. Your state of mind can affect the amount of pain and discomfort you feel. Talking to a professional who isn’t emotionally involved can help.

This could be a:

  • counsellor
  • psychotherapist
  • spiritual adviser or faith leader

Speak to your Marie Curie Nurse or district nurse about getting this kind of support.

Complementary therapy

Complementary therapies are often available to people with a terminal illness. They can help calm the mind and body, help you to sleep and subsequently reduce pain. Common therapies include: meditation, aromatherapy and reiki.

Music therapy has been found to be beneficial in easing pain. Studies have also shown that reiki, combined with massage, can help to reduce pain and anxiety. Your Marie Curie Nurse, health assistant or the district nurse can help you find out what local free services there are.

External websites

British Acupuncture Council  

NHS Choices   – medicine A-Z


This content is provided for general information purposes only. It's not medical, financial, legal or personal advice. We suggest that you consult with a qualified professional about your individual circumstances. How our information is created and how it's used.

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