In English | En español
Questions About Cancer? 1-800-4-CANCER

Pain (PDQ®)

  • Updated: 09/03/2014

Table 7. Adjuvant Medications With Analgesic Activity

Class Drug Daily Dose Rangea Studies Conducted in: 
   Cancer Patients  Noncancer Patients  
Antidepressantsamitriptyline (Elavil)10–25 mg every day[208][Level of evidence: I][209][Level of evidence: I][210][Level of evidence: I]
desipramine (Norpramin)10–150 mg every day[211][Level of evidence: II][212][Level of evidence: II]
maprotiline (Ludiomil)25 mg bid–50 mg tid[213][Level of evidence: I]
duloxetine (Cymbalta)20 mg bid–30 mg bid[214][Level of evidence: I]
nortriptyline (Pamelor, Aventyl)10–100 mg every day[215][Level of evidence: I]
venlafaxine (Effexor)37.5–225 mg every day[216][Level of evidence: I][217][Level of evidence: II][218][Level of evidence: I]
Anticonvulsantscarbamazepine (Tegretol)100 mg tid–400 mg tid[219][Level of evidence: I]
valproate (Depacon)500 mg tid–1,000 mg tid[220][Level of evidence: I]
gabapentin (Neurontin)100 mg tid–1,000 mg tid[221][Level of evidence: I][222][Level of evidence: II][223][Level of evidence: II]
clonazepam (Klonopin)0.5 mg bid–4 mg bid[224][Level of evidence: II]
lamotrigine (Lamictal)25 mg bid–100 mg bid[225][Level of evidence: I]
pregabalin (Lyrica)150 mg divided into 2 or 3 doses; increase to 300 mg starting at day 3–7; if needed, increase to 600 mg 7 days later[226][Level of evidence: I]
Local anestheticsmexiletine (Mexitil)100 mg bid–300 mg tid[227][Level of evidence: I]
lidocaine patch (Lidoderm)5% patch contains 700 mg; one patch, 12 hours on, 12 hours off[228][Level of evidence: II]
Corticosteroidsdexamethasone (Decadron)See text
prednisoneSee text
BisphosphonatesclodronateSee text
pamidronate (Aredia)See text
zoledronic acid (Zometa)See text[229][Level of evidence: II]
NSAIDsRefer to Table 1 for more information.
Miscellaneousbaclofen (Lioresal)5 mg tid–20 mg tid[230][Level of evidence: I]
calcitonin (Calcimar)100–200 IU (subcutaneous or intranasal)
clonidine (Catapres)0.1 mg bid–0.3 mg bid[231]
methylphenidate (Ritalin)2.5 mg bid–20 mg bid[232][Level of evidence: I][233][Level of evidence: II]
ketamine (Ketalar)Refer to the NMDA Receptor Antagonists section of this summary for more information.

bid = twice a day; tid = 3 times a day.
aStarting doses should incorporate the lowest possible dose.

References

  1. Kalso E, Tasmuth T, Neuvonen PJ: Amitriptyline effectively relieves neuropathic pain following treatment of breast cancer. Pain 64 (2): 293-302, 1996.  [PUBMED Abstract]

  2. Mercadante S, Arcuri E, Tirelli W, et al.: Amitriptyline in neuropathic cancer pain in patients on morphine therapy: a randomized placebo-controlled, double-blind crossover study. Tumori 88 (3): 239-42, 2002 May-Jun.  [PUBMED Abstract]

  3. Leijon G, Boivie J: Central post-stroke pain--a controlled trial of amitriptyline and carbamazepine. Pain 36 (1): 27-36, 1989.  [PUBMED Abstract]

  4. Holland JC, Romano SJ, Heiligenstein JH, et al.: A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psychooncology 7 (4): 291-300, 1998 Jul-Aug.  [PUBMED Abstract]

  5. Max MB, Kishore-Kumar R, Schafer SC, et al.: Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial. Pain 45 (1): 3-9; discussion 1-2, 1991.  [PUBMED Abstract]

  6. Vrethem M, Boivie J, Arnqvist H, et al.: A comparison a amitriptyline and maprotiline in the treatment of painful polyneuropathy in diabetics and nondiabetics. Clin J Pain 13 (4): 313-23, 1997.  [PUBMED Abstract]

  7. Raskin J, Pritchett YL, Wang F, et al.: A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med 6 (5): 346-56, 2005 Sep-Oct.  [PUBMED Abstract]

  8. Raja SN, Haythornthwaite JA, Pappagallo M, et al.: Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 59 (7): 1015-21, 2002.  [PUBMED Abstract]

  9. Tasmuth T, Härtel B, Kalso E: Venlafaxine in neuropathic pain following treatment of breast cancer. Eur J Pain 6 (1): 17-24, 2002.  [PUBMED Abstract]

  10. Reuben SS, Makari-Judson G, Lurie SD: Evaluation of efficacy of the perioperative administration of venlafaxine XR in the prevention of postmastectomy pain syndrome. J Pain Symptom Manage 27 (2): 133-9, 2004.  [PUBMED Abstract]

  11. Rowbotham MC, Goli V, Kunz NR, et al.: Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study. Pain 110 (3): 697-706, 2004.  [PUBMED Abstract]

  12. Harke H, Gretenkort P, Ladleif HU, et al.: The response of neuropathic pain and pain in complex regional pain syndrome I to carbamazepine and sustained-release morphine in patients pretreated with spinal cord stimulation: a double-blinded randomized study. Anesth Analg 92 (2): 488-95, 2001.  [PUBMED Abstract]

  13. Kochar DK, Garg P, Bumb RA, et al.: Divalproex sodium in the management of post-herpetic neuralgia: a randomized double-blind placebo-controlled study. QJM 98 (1): 29-34, 2005.  [PUBMED Abstract]

  14. Caraceni A, Zecca E, Bonezzi C, et al.: Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol 22 (14): 2909-17, 2004.  [PUBMED Abstract]

  15. Ross JR, Goller K, Hardy J, et al.: Gabapentin is effective in the treatment of cancer-related neuropathic pain: a prospective, open-label study. J Palliat Med 8 (6): 1118-26, 2005.  [PUBMED Abstract]

  16. Levendoglu F, Ogün CO, Ozerbil O, et al.: Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury. Spine 29 (7): 743-51, 2004.  [PUBMED Abstract]

  17. Hugel H, Ellershaw JE, Dickman A: Clonazepam as an adjuvant analgesic in patients with cancer-related neuropathic pain. J Pain Symptom Manage 26 (6): 1073-4, 2003.  [PUBMED Abstract]

  18. Simpson DM, McArthur JC, Olney R, et al.: Lamotrigine for HIV-associated painful sensory neuropathies: a placebo-controlled trial. Neurology 60 (9): 1508-14, 2003.  [PUBMED Abstract]

  19. Lesser H, Sharma U, LaMoreaux L, et al.: Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology 63 (11): 2104-10, 2004.  [PUBMED Abstract]

  20. Oskarsson P, Ljunggren JG, Lins PE: Efficacy and safety of mexiletine in the treatment of painful diabetic neuropathy. The Mexiletine Study Group. Diabetes Care 20 (10): 1594-7, 1997.  [PUBMED Abstract]

  21. Meier T, Wasner G, Faust M, et al.: Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomized, double-blind, placebo-controlled study. Pain 106 (1-2): 151-8, 2003.  [PUBMED Abstract]

  22. Polascik TJ, Given RW, Metzger C, et al.: Open-label trial evaluating the safety and efficacy of zoledronic acid in preventing bone loss in patients with hormone-sensitive prostate cancer and bone metastases. Urology 66 (5): 1054-9, 2005.  [PUBMED Abstract]

  23. Dapas F, Hartman SF, Martinez L, et al.: Baclofen for the treatment of acute low-back syndrome. A double-blind comparison with placebo. Spine 10 (4): 345-9, 1985.  [PUBMED Abstract]

  24. Lavand'homme PM, Eisenach JC: Perioperative administration of the alpha2-adrenoceptor agonist clonidine at the site of nerve injury reduces the development of mechanical hypersensitivity and modulates local cytokine expression. Pain 105 (1-2): 247-54, 2003.  [PUBMED Abstract]

  25. Bruera E, Chadwick S, Brenneis C, et al.: Methylphenidate associated with narcotics for the treatment of cancer pain. Cancer Treat Rep 71 (1): 67-70, 1987.  [PUBMED Abstract]

  26. Cantello R, Aguggia M, Gilli M, et al.: Analgesic action of methylphenidate on parkinsonian sensory symptoms. Mechanisms and pathophysiological implications. Arch Neurol 45 (9): 973-6, 1988.  [PUBMED Abstract]