Managing Pancreatic Cancer Pain: Treatment Options and Relief
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Pain Medicines
Several medications can treat pain with pancreatic cancer, including opioids and over-the-counter options.
“There’s no one single best medicine,” says Dr. Arora. The medicine you need depends on the type of pain you’re having most, and that can change day to day, week to week, he says.
Your care team will work with you continually, helping you understand which type of pain medicines you need and when to take them, says Arora.
Over-the-Counter Medications
For mild to moderate pain, your provider may suggest an over-the-counter medication taken by mouth. These include:
acetaminophen (Tylenol)
ibuprofen (Advil, Motrin)
aspirin
When taken over long periods, these medications can cause side effects like liver damage, kidney damage, and stomach inflammation, pain, or ulcers.
Opioids
Opioids treat moderate to severe pancreatic cancer pain. Your provider may recommend different options based on your pain level, type, and location.
Opioid medications include:
fentanyl (Duragesic)
tramadol (Ultram)
hydrocodone and acetaminophen (Vicodin, Norco, Lortab)
oxycodone (OxyContin, Roxicodone)
oxycodone with acetaminophen (Percocet)
morphine (MS Contin, Oramorph)
methadone (Methadose)
buprenorphine (Suboxone, Subutex)
These medications can be taken through different routes, which may include pills, liquid, injections, or transdermal patches (stickers placed on your skin that release medication slowly over days).
“Many patients with pancreatic cancer have some degree of gastrointestinal (GI) symptoms and absorption issues,” says Rebecca Goett, MD, a palliative medicine specialist at Hackensack Meridian Jersey Shore University Medical Center and an associate professor at Hackensack Meridian School of Medicine.
“For that reason, for long-acting pain medications, I prefer transdermal patches such as buprenorphine or fentanyl patches, because their absorption bypasses the GI system,” says Dr. Goett.
You can also take buprenorphine under your tongue or against your cheek at higher concentrations, which mostly bypasses stomach absorption as well, says Goett.
Opioids can cause side effects like constipation, nausea, itching, drowsiness, and sometimes difficulty breathing. Tell your provider right away if you notice changes in breathing after taking your medication.
Nerve Pain Medications
Other medication types can be used to manage nerve pain caused by pancreatic cancer. These include:
amitriptyline (Elavil)
nortriptyline (Aventyl, Pamelor)
gabapentin (Neurontin)
phenytoin (Dilantin)
venlafaxine (Effexor)
duloxetine (Cymbalta)
Antidepressants like venlafaxine and duloxetine often involve fewer pills than anti-seizure medications like gabapentin, says Arora, which can make them easier to take.
These medications can cause side effects like drowsiness, nausea, dizziness, dry mouth, headaches, and constipation.
Steroids
Steroids lessen inflammation, which can improve pain from pressure and swelling caused by a pancreatic tumor. You can take steroids as a pill called prednisone (Deltasone, Orasone). Dexamethasone (Decadron), another steroid, is given through an IV.
You can’t take steroids over long periods because they tend to cause side effects like high blood sugar, insomnia, weak bones, stomach ulcers, and a depressed immune system.
Pain Pump
For severe pain that doesn’t get better with the medications above, your provider may suggest an intrathecal drug delivery system: a surgically placed catheter (tube) that delivers pain medication to the fluid that surrounds your spinal cord.
This catheter attaches to a machine (pain pump) placed under your skin. This pump gives you opioid medication. People often need much less medication through this route than with opioids given by mouth or IV. Its most common side effects are bleeding and infection at the surgical site.
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