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These medicines are stronger pain relievers than most people think. In many cases, non-opioids might be all you’ll need to relieve your pain, especially if you take the pain relievers regularly or as soon as you start to feel pain. Don’t wait until your pain is bad. Waiting too long can make the pain harder to treat.

Non-opioids, like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) can help control mild to moderate pain. Acetaminophen can relieve mild-to-moderate pain and reduce fever, but it lacks aspirin’s anti-inflammatory effect. Although it can relieve the pain caused by inflammation, it can’t reduce the inflammation itself. Some can be bought over the counter without a prescription.

Acetaminophen

Acetaminophen is commonly known as Tylenol. It relieves mild to moderate pain. People rarely have side effects from the usual dose of acetaminophen.

Be careful to take acetaminophen as the label directs because it is possible to take too much. If you take large doses of this medicine every day for a long time or drink alcohol with the usual dose, liver and kidney damage can happen. Alcohol should be limited to no more than 2 drinks per day for men and 1 drink a day for women.

You also need to be careful about taking other medicines that include acetaminophen.

See the section on Precautions about aspirin, acetaminophen, and ibuprofen in other medicines.

Your doctor may not want you to take acetaminophen if you’re getting chemotherapy because it can hide a fever. Your doctor needs to know if you have a fever because it could mean you have an infection, which needs to be treated quickly.

Nonsteroidal anti-inflammatory drugs (NSAIDS)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help treat pain and inflammation, either alone or with other medicines. Before you take any NSAIDs or other non-opioids, ask your cancer care team if it’s safe for you to take it with your other medicines, and how long you can take it.

Precautions when you are taking NSAIDs

Some people are more likely to be harmed by  NSAIDs. In general, don’t take NSAIDs if you:

• Are allergic to aspirin or any other NSAIDs
• Are getting chemotherapy
• Are taking steroids
• Are taking blood pressure medicines
• Have stomach ulcers or a history of ulcers, gout, or bleeding disorders
• Are taking oral medicine (drugs by mouth) for diabetes or gout
• Have kidney problems
• Will have surgery within a week
• Are taking blood-thinning medicine
• Are taking lithium

If you drink alcohol, be careful taking NSAIDs. It can cause stomach upset and raise the risk of having reflux or bleeding in the stomach. Smoking may also increase this risk. NSAIDs may also raise your risk of heart attack or stroke, especially if you take them for a long time.

Aspirin, acetaminophen, and ibuprofen in other medicines

Some opioids also contain aspirin or acetaminophen in the same pill. A few also contain ibuprofen. It can be dangerous if you take medicines without knowing what’s in them. Check labels if you are taking acetaminophen, aspirin or NSAIDS.

Other medicines used to help treat cancer pain

Many other medicines can be used with (or instead of) opioids and non-opioids to help relieve cancer pain. These medicines can help relieve pain or increase the effect of the pain medicine. Others lessen the side effects of pain medicines. These medicines are often started at low doses and increased over time.

The medicines listed below are not really pain medicines but might be used to help you get the best pain relief with as few side effects as possible.

• Antidepressants treat tingling or burning pain from damaged nerves (peripheral neuropathy)
• Anti-anxiety drugs treat muscle spasms that may be with severe pain.
• Anti-convulsant help control tingling or burning from nerve pain caused by the cancer or cancer treatment.
• Stimulants and amphetamines increase the pain-relieving action of opioids and reduce the drowsiness they cause.
• Steroids help relieve bone pain, pain caused by spinal cord and brain tumors, and pain caused by inflammation.
• Psychoactive substances help with pain by affecting how the brain works and causing changes in mood, awareness, thoughts, feelings, or behavior. Examples of psychoactive substances include caffeine and marijuana.

Be sure to talk to your cancer care team about these medicines, how they work, and their possible side effects.