There are several options that can be considered for pain relief with bone pain.
Tylenol® is the brand name of acetaminophen. It’s a good painkiller for bone pain, but it may not be strong enough to relieve completely the pain of cancer in the bones. The maximum dose of acetaminophen is 4,000 mg a day. It’s very important to check with the physician before taking a dose close to this upper daily limit. Doses near the maximum may be unsafe, as they may affect the liver or cause other serious problems.
Anti-inflammatory agents are often used for bone pain, but they may have serious side effects such as kidney damage and intestinal bleeding. There is no good evidence that they’re more effective in relieving bone cancer pain than Tylenol® or low dosages of opioids. While serious side effects are uncommon, the physician prescribing the medication needs to consider all the risks and benefits of these types of medications for a given situation.
If a regular dosage of Tylenol® is not effective, then a low dosage of an opioid is usually added. As a first step, this is often done by using Tylenol with codeine. This can be Tylenol® #2 or Tylenol® #3. Both contain a combination of acetaminophen and codeine. Codeine is called a pro-drug. This means the body itself changes the codeine into the effective drug, in this case morphine. Some people’s bodies don’t have the capability to make codeine into morphine, and in such circumstances it’s important to use a different pain medication.
If someone is taking regular dosages of Tylenol® #3 and still feels discomfort, then it is usually time to start taking morphine or something similar. For many people, this is a frightening concept, but it is useful to realize that codeine is really morphine in another form. People taking codeine convert it to morphine in their bodies, and have adjusted to morphine already.
Other pain relief options may depend on the tumor involved. Some tumors start in the bone, but more commonly in adults the cancer starts somewhere else and spreads to the bone. Radiation therapy, hormone therapy, chemotherapy and medications called bisphosphonates all may help relieve bone pain. Discussion with the health care team can determine the best option for each person’s circumstances, as there are many factors to consider.
Any time someone is using opioid medications (including codeine), there needs to be attention to the bowels. Constipation is almost always an issue, and laxatives such as docusate and Senokot® need be taken while on opioids.