Analgesics are medications given to relieve pain. Breast cancer patients who experience pain have many options for selecting analgesics, depending on the cause (i.e., symptom of the disease or side effect of treatment) of the pain.
If you are a breast cancer patient undergoing treatment who has begun to feel pain or is experiencing an increase in pain, consult your oncologists for guidance on the specific analgesic, dose, and the type of administration of the analgesic that are appropriate for you. Types of administration of analgesics include:
• Topical (i.e., applied to the skin). Examples are gels, lotions, creams, ointments, and liniments.
• Transdermal (i.e., patch applied to the skin)
• Oral (i.e., taken by mouth) transmucosal (i.e., delivers medication through the mucous membranes).
• Oral (i.e., taken by mouth). Examples are tablets, capsules, and liquids.
• Rectal. Examples are suppositories.
• Intravenous (IV; injected into a vein)
Pain medications are selected on the basis of the degree of severity of pain. A scale of 1 (meaning the absence of pain) to 10 (meaning extremely severe pain) is used to rate the severity of pain. According to guidelines from the World Health Organization (WHO), certain classes of analgesics are used for different degrees of severity of pain.
Classes of Analgesics for Mild-to-Moderate (Rating of 1-3) Pain:
• Non-prescription (over-the-counter) topical menthol-containing preparations. Rubbing the menthol-containing preparations into the skin of the affected area may promote the circulation of blood; give a warm, soothing or cool, soothing sensation lasting several hours; and relieve pain. Before using menthol-containing preparations, be sure to consult your oncologists to determine whether the topical preparations are appropriate, considering the treatments you are receiving and your current medical condition.
• Non-prescription (over-the-counter) oral Tylenol (acetominophen)
• Non-prescription (over-the-counter) oral, non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen)
Classes of Analgesics for Moderate-to-Severe (Rating of 4-6) Pain:
• Prescription oral, moderate-strength opiod (narcotic) preparations, such as codeine plus Tylenol, codeine plus an NSAID, oxycodone plus Tylenol, oxycodone plus an NSAID, hydrocodone plus Tylenol, hydrocodone plus an NSAID, dihydrocodeine, propoxyphene, or tramadol.
Classes of Analgesics for Mild-to-Moderate (Rating of 7-10) Pain:
• Prescription transmucosal delivery of strong opiods (narcotics), such as fentanyl.
• Prescription transdermal, strong opiods (narcotics), such as the fentanyl patch, which provides long-lasting relief.
• Prescription injectable strong opiods (narcotics), such as oxycodone, fentanyl, hydromorphone, levorphanol, methadone, or morphine. Certain preparations of oxycodone and morphine are available in immediate-release formulations, which provide rapid relief. Other preparations of oxycodone and morphine are available in extended-release formulations, which provide long-lasting relief.
Different analgesics may produce various side effects, including
• Sleepiness
• Constipation
• Nausea and vomiting
If you experience any side effects from analgesics, consult your oncologist and oncology nurse. For information on managing side effects of analgesics, see our Q&As on the particular side effect.
REFERENCE
1. Managing pain. Accessed at www.chemotherapy.com
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