Pain relief and common side effects
Pain is common for people living with terminal illness. Everyone experiences pain in their own way, and everyone responds to it differently. There are many medicines (sometimes called drugs) you can take to help with your pain. There are also things you can do to manage your pain that do not involve medicines. Your doctors, nurses and other members of your healthcare team will work with you to help get your pain under control.
On this page:
Dealing with pain
We often think of pain as a physical sensation caused by damage to our bodies. But we also know that lots of different factors can influence how we feel pain. These include feeling stressed, anxious, worried, tired or alone.
Most pain can be kept under control with medicines. In fact, it's rare for someone to have pain that cannot be kept under control. But we know that it's easier to manage pain when you feel you have the right emotional, psychological and spiritual support as well.
You may find that it helps to talk to a professional. This could be a:
- counsellor
- psychotherapist
- spiritual adviser or faith leader.
Speak to your doctor or nurse about getting this kind of support if you think it might help you.
Read more information about the different types of psychological support.
Pain assessment
Your doctor or palliative care team will need to assess your pain to decide the best treatment for you. They will ask you some questions about your pain and may do a physical examination. Sometimes they'll need to arrange tests to find out what's causing the pain. They might do a blood test to help them decide the most suitable medicine for you.
Find out more about pain assessments.
Pain medicines
There are lots of different medicines for treating pain. Some of them work better for different types or severities (amount) of pain.
It can take a while to find the medicines that work best for you. Tell your doctor or nurse if your pain gets worse or feels different. They can increase your dose or give you a new medicine to try.
You might find that a combination of pain medicines works best. It's common to take simple painkillers alongside opioids, for example. You might also find that combining medicines with non-drug treatments works better for you.
Pain relief medicines
Simple painkillers for mild pain
Paracetamol
What it's used for and how it works:
- Can be used on its own for most types of mild pain.
- Can be used alongside stronger medicines for severe pain.
Common side effects:
- Paracetamol rarely causes side effects.
NSAIDs (non-steroidal anti-inflammatory drugs)
NSAIDs include:
- aspirin
- naproxen
- ibuprofen (Nurofen®, Brufen®).
What they're used for and how they work:
- These can come as tablets or in a gel that you rub into the painful part of your body.
- NSAIDs work well for pain caused by inflammation. They can be helpful in cancer pain as cancer often causes inflammation.
- NSAIDs are also used to relieve bone pain.
Common side effects:
- Irritation of the stomach or bowel, ulcers and bleeding from the stomach and bowel. Medicines can be prescribed to protect the stomach lining.
- Should be avoided if you have severe heart failure.
- Must be used with caution and under medical supervision if you have kidney failure.
Please note: Using NSAIDs long-term can cause side effects. Speak with your healthcare professional so they can support you.
Weak opioids for moderate pain
Weak opioids include:
- Codeine
- Dihydrocodeine (DF118 Forte®)
- Tramadol hydrochloride (Zydol®, Tramacet®).
What they're used for and how they work:
- These are stronger painkillers. They are used for moderate pain.
All opioids can cause the following side effects:
- Constipation – this can be eased by laxatives (medicines which help someone go to the toilet). Laxatives need to be taken regularly to work effectively.
- Nausea and vomiting – this usually wears off after a few days. Anti-emetic (anti-sickness) medicines can stop this. They can be taken for the first few days.
- Sleepiness or drowsiness.
- If you feel extremely drowsy, have jerking movements or find it hard to breathe, contact your doctor or nurse. These are all signs that your dose may be too high for you.
Strong opioids for severe pain
Strong opioids include:
- Morphine
- Diamorphine
- Methadone
- Oxycodone (OxyNorm® and OxyContin®)
- Buprenorphine (Transtec® patches, BuTrans® patches)
- Fentanyl (Durogesic®, Mezolar patches®).
What they're used for and how they work:
- Strong opioids can be given for many types of moderate and severe pain.
- Addiction in people with terminal illness is very rare.
- They can be given as tablets, injections, liquids, in a patch on your skin or through a syringe driver (a pump which delivers medications under the skin). Read more information about syringe drivers.
- Oramorph (oral morphine) is swallowed as a liquid. It's often used to treat breakthrough pain (a sudden worsening of pain).
All opioids can cause the following side effects:
- Constipation – this can be eased by laxatives (medicines which help someone go to the toilet). Laxatives need to be taken regularly to work effectively.
- Nausea and vomiting. This usually wears off after a few days. Anti-emetic (anti-sickness) medicines can stop this. They can be taken for the first few days.
- Sleepiness or drowsiness.
- If you feel extremely drowsy, have jerking movements or find it hard to breathe, contact your doctor or nurse. These are all signs that your dose may be too high for you.
Other medicines used to treat pain
Anti-depressants
These include:
- Amitriptyline
- Nortriptyline
- Duloxetine
- Mirtazapine.
What they're used for:
- These are usually used to treat depression, but are also very good at treating nerve (neuropathic) pain.
Common side effects:
- Side effects are usually mild and improve after a few days. You might get nausea, dizziness or a dry mouth.
Anti-convulsants (anti-seizure)
These include:
- Gabapentin (Neurontin®)
- Pregabalin (Lyrica®).
What they're used for:
- These are usually used to prevent seizures (fits) but can also relieve nerve (neuropathic pain).
Common side effects:
- They can sometimes cause weakness, tiredness and blurred vision.
Anti-spasmodics
These include:
- Hyoscine butylbromide (Buscopan®)
- Hyoscine hydrobromide
- Mebeverine (Colofac®).
What they're used for and how they work:
- These can relieve colic (crampy pains in the tummy). They work by relaxing the bowel.
Common side effects:
- Hyoscine butylbromide (Buscopan®) and hyoscine hydrobromide can commonly cause a dry mouth. Drinking water and sucking boiled sweets can help with this.
- These medicines can also cause constipation.
Steroids
These include:
- Dexamethasone
- Prednisolone.
What they're used for and how they work:
- 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.
Side effects include:
- Common side effects of steroids are difficulty sleeping and increased appetite. High doses can increase your blood sugar. This will need to be monitored.
- When used in the longer term, they can make it harder for your body to fight infections and make your skin thinner, so you bruise more easily.
Bisphosphonates
These include:
- Pamidronate (Aredia®)
- Ibandronic acid or ibandronate (Bondronat®)
- Sodium clodronate (Bonefos®, Clasteon®, Loron®)
- Zoledronic acid or zoledronate (Zometa®).
What they're used for and how they work:
- These are sometimes used for bone problems such as osteoporosis. They relieve bone pain by working directly on the tissue of the bones.
Common side effects:
- They can cause headaches, sickness, and diarrhoea.
- They can also affect your kidneys. So, your doctor should monitor your kidney function if they are prescribed for you.
If your pain medicines are not listed here, ask your doctor, nurse or pharmacist for more information.
When to take pain medicines
Some people think they should wait until the pain is really bad before taking any painkillers. It is better to take painkillers as often as your doctor prescribed, even if you're not experiencing pain at the time. This helps to keep the pain under control between doses.
Names of medicines
Lots of drugs have more than one name. In the table above, the generic name for the drug is first, with some of the common trade names in brackets afterwards. For example, ibuprofen is the generic name and Nurofen® and Brufen® are trade names. They are different names for the same medicine.
Other treatments
If your pain cannot be controlled by medicines, there are other options for treatment of pain. Palliative care doctors work closely with anaesthetists. They are doctors who specialise in treating pain. An anaesthetist might be able give you a nerve block or medicine into your spine.
Nerve blocks are when pain medicines, steroids or local anaesthetic (numbing medicine) are injected in your nerves. This stops them from detecting pain and sending messages to your brain, meaning you do not feel pain in that part of your body.
Spinal therapy is when medicines are injected into the fluid around your spinal cord. This blocks the pain messages travelling from your spinal cord to your brain.
Both of these treatments are usually provided in hospital by specialist doctors and nurses.
Side effects
All medicines can cause side effects. These are effects a drug has that are in addition to the effects we want. You might have one or more side effects, or you might not have any at all. We have listed some of the common side effects for each medicine in the table above. They can cause other side effects as well. Ask your doctor or pharmacist about specific side effects for your medicines.
If you have side effects, talk to your doctor or nurse. Do not stop taking your medicines suddenly or change the dose without talking to them. They may be able to change the dose, try different medicines or help you to manage side effects.
Common worries about opioids
A lot of people worry about taking morphine or other opioids.
Some people worry that having morphine can make them die more quickly. This is not true. Morphine and other opioids are very safe and effective when prescribed and taken correctly. Morphine and other strong painkillers can even be taken for a long time.
Some people think that being given opioids means you are near the end of your life. This is not true. Opioids can be given to people who are not terminally ill, but opioids are often used to manage someone's pain when they are at the end of their life too.
You or your friends and family might also be worried about the risk of addiction, particularly if you're using a syringe driver or taking other strong painkillers. This is not something to worry about. Becoming addicted to opioids is rare for people needing pain relief for terminal illness.
If you're worried about any of these things, speak to your doctor or nurse. They can tell you what medicines might be suitable for you and answer any questions you might have.
Drug-free pain relief
TENS machine
TENS (transcutaneous electrical nerve stimulation) machines deliver a gentle electric pulse that can help reduce pain. You can attach electrodes to your body wherever you feel pain. The pulse might tingle a bit, but it's not painful.
The machine is easy to use and you can try it at home. You can buy them at lots of pharmacies. If you're interested in trying a TENS machine, talk to your GP. They can refer to you a physiotherapist or pain specialist who can help you to set it up.
Acupuncture
Acupuncture involves having very thin needles inserted into certain parts of your body. It's safe and sometimes effective at treating chronic pain. Check with your doctor if it might be suitable for you. Acupuncture might be available in your local hospice or hospital, or through your GP or a private practitioner. Contact the British Acupuncture Council for more information.
Heat and cold
Heat and cold therapies might help with pain relief. Hot water bottles and warm baths can reduce pain, ease stiffness, and increase muscle relaxation and circulation. Using an ice pack on certain parts of your body might help reduce pain and swelling too.
For safety, make sure that you:
- do not use boiling water in a hot water bottle
- wrap a hot water bottle or ice pack in a towel or pillowcase to avoid burns to your skin
- only apply heat or cold therapy to your body for 10 - 15 minutes
- do not go to sleep while using the treatment.
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 reduce pain. Common therapies include mindfulness, meditation, massage, aromatherapy, reflexology, hypnotherapy, music therapy and reiki. Your doctor or nurse can help you find out what services there are in your area.
Occupational therapy and physiotherapy
Occupational therapists (OTs) and physiotherapists can help you to manage your pain. They might make changes to your home to make moving around less painful, for example. Or they might suggest changing positions regularly or using special cushions to ease pain in particular areas.
Talk to your GP or nurse if you want to see a physiotherapist or occupational therapist.
Information for friends and family
If your friend or family member has a terminal illness you might be supporting them in lots of different ways, including helping them with medication. We have more information on how to help someone with medication.
As well as giving them medicines, there are other ways that you can help the person to manage their pain. People often feel less pain when they feel relaxed and supported. They can also be distracted from their pain when they have meaningful things to do.
You can help them to feel more comfortable by:
- spending time with them
- listening to their worries
- helping them to talk about their feelings
- helping them to relax by playing music or reading to them
- helping them do their favourite activities such as reading or seeing friends.
Ask the nurse if there is a carers support group in your local area where you can get more support with this. Read more tips on our page about helping someone relax.
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About this information
This information is not intended to replace any advice from health or social care professionals. We suggest that you consult with a qualified professional about your individual circumstances. Read more about how our information is created and how it's used.
