A: First we ask them, "Where is it hurting?" Then we usually ask them, "If zero is no pain at all and 10 is the worst possible, how bad does it hurt on average?" The other thing it would be nice for them to notice is what makes it better—a certain position, rubbing it? What makes it worse—walking, coughing, a certain position? That might help us figure out why the pain is there. Then it is very useful to know how it responds to painkillers. What did they take, how long did it take to work, and how long did the pain improvement last? Those are very useful pieces of information to then decide the next step.
Q: What are the first-line drugs for cancer pain?
A: If people have a pain that is just starting and is not really very high, it can be treated initially with nonsteroidal anti-inflammatory drugs (NSAIDs), or even plain acetaminophen. If the pain is a little bit more problematic, we usually start what are called opioid analgesics (derived from the opium poppy plant or made synthetically), which act on a receptor that we have in the spinal cord and the brain. They act on the intensity of the pain. There are mild opioids, such as codeine or hydrocodone products that are usually given in combination with acetaminophen or aspirin, or strong opioids like morphine, methadone, and fentanyl. Those are the most powerful treatments we have. The main opioid we use, morphine, has been around for some 200 years. Most of the opioids we use have been effective for 60 to 80 years, which means we know them well and they are usually quite safe when used appropriately.
Why Patients Don't Talk About Cancer Pain
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More about cancer pain
A: The number one treatment for patients with cancer who develop pain are the so-called analgesics, the nonsteroidals or the opioids. We always start with those first. The addition of other drugs, like antidepressants, anticonvulsants, or corticosteroids happens mostly when the painkiller alone is not able to control the pain. In most cases, the painkiller alone is effective. In general the studies have not shown that one painkiller is better than another. We, as patients, have different responses to one painkiller or another, but as a group you do not find differences between one painkiller and another.
