Q: What are the first-line drugs for cancer pain?

A: If people have a pain that is just starting and is not really very high, it can be treated initially with nonsteroidal anti-inflammatory drugs (NSAIDs), or even plain acetaminophen. If the pain is a little bit more problematic, we usually start what are called opioid analgesics (derived from the opium poppy plant or made synthetically), which act on a receptor that we have in the spinal cord and the brain. They act on the intensity of the pain. There are mild opioids, such as codeine or hydrocodone products that are usually given in combination with acetaminophen or aspirin, or strong opioids like morphine, methadone, and fentanyl. Those are the most powerful treatments we have. The main opioid we use, morphine, has been around for some 200 years. Most of the opioids we use have been effective for 60 to 80 years, which means we know them well and they are usually quite safe when used appropriately.