What painkillers can I take while on chemotherapy?

October 8, 2025 •

4 min read

For many patients, pain is a common side effect of cancer or its treatment, including chemotherapy. A staggering 69% to 100% of cancer pain cases can be successfully treated with the right medications, but it's essential to understand what painkillers can I take while on chemotherapy to ensure safety and effectiveness.

Quick Summary

Pain during chemotherapy is manageable, but requires careful consideration of medication options. This guide reviews safe painkiller choices, including acetaminophen for mild pain, opioids for more severe cases, and adjuvant therapies for specific types of discomfort, while highlighting important contraindications and risks.

Key Points

Always Consult Your Care Team: Before taking any painkiller, including OTC options, you must consult your oncologist due to potential interactions and side effects.
Acetaminophen is Often Safest: For mild to moderate pain, acetaminophen (Tylenol) is frequently the safest choice because it doesn't interfere with blood clotting.
Avoid Most NSAIDs: Due to the risk of bleeding and kidney damage, NSAIDs like ibuprofen, naproxen, and aspirin are generally not recommended during chemotherapy.
Opioids for Severe Pain: For moderate-to-severe pain, prescription opioids like morphine or oxycodone are effective and carefully managed by your care team.
Consider Adjuvant Medications: For nerve-related pain (neuropathy), antidepressants (duloxetine) or anticonvulsants (gabapentin) can be prescribed.
Never Mask a Fever: Acetaminophen can hide a fever, a critical sign of infection during neutropenia, so inform your doctor immediately if you have one.
Integrative Therapies Help: Complementary approaches like massage, acupuncture, and meditation can supplement medication and aid in pain relief.

A personalized approach to pain management

Pain management during chemotherapy is a highly individualized process that must be overseen by your cancer care team. The right medication depends on the type and severity of your pain, your chemotherapy regimen, and any potential side effects or complications, such as low blood cell counts or organ function changes. Never start, stop, or change a pain medication without consulting your oncologist or pharmacist.

Over-the-counter options: Acetaminophen vs. NSAIDs

For mild to moderate pain, over-the-counter (OTC) pain relievers are often the first line of defense, but not all are safe during chemotherapy.

Acetaminophen (Tylenol)

Acetaminophen is generally considered the safest and most commonly recommended OTC painkiller for patients on chemotherapy.

It is effective for mild-to-moderate pain relief and reducing fever.
It does not affect platelet function, making it safer for patients with low platelet counts (thrombocytopenia) and an increased risk of bleeding.

However, it's not without risks, especially if you have liver or kidney issues, which can sometimes be exacerbated by chemotherapy. High doses or prolonged use can cause liver and kidney damage. A critical point for patients is that acetaminophen can mask a fever, a key sign of infection, which can be life-threatening during chemotherapy-induced neutropenia (low white blood cell count). Your care team needs to know if you have a fever immediately, and taking acetaminophen could hide this important warning sign.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs like ibuprofen (Advil, Motrin), aspirin, and naproxen (Aleve) are generally not recommended for patients undergoing chemotherapy due to significant risks.

Increased Bleeding Risk: NSAIDs inhibit platelet function, increasing the risk of bleeding or bruising, especially for patients with chemotherapy-induced thrombocytopenia.
Kidney Damage: Chemotherapy drugs can already put a strain on the kidneys. NSAIDs can cause or worsen kidney problems, especially when taken with certain chemotherapy agents like methotrexate.
Masking Fever: Like acetaminophen, NSAIDs can lower a fever, hiding signs of infection that require immediate medical attention.

Some newer NSAIDs, known as COX-2 inhibitors (e.g., celecoxib), may have a lower risk of certain side effects, but their use still requires careful consideration and oncologist approval.

Prescription opioids for moderate to severe pain

When pain is moderate to severe, prescription opioids are often necessary and effective. Your doctor will typically prescribe them on a regular, scheduled basis rather than on an as-needed basis to keep pain controlled before it becomes severe.

Commonly used opioids for cancer pain include:

Morphine
Oxycodone
Fentanyl (often via a transdermal patch)
Hydromorphone

Opioids carry potential side effects, including:

Constipation
Nausea and vomiting
Drowsiness
Confusion

Your care team will help you manage these side effects, often prescribing laxatives to prevent constipation. Though a small number of patients can become psychologically dependent on opioids, for cancer pain, the focus is on achieving the best possible quality of life by managing pain effectively.

Adjuvant medications for specific types of pain

Adjuvant analgesics are drugs primarily used for other conditions but have also been proven effective for specific types of cancer pain, particularly neuropathic pain caused by nerve damage from chemotherapy.

Examples include:

Antidepressants: Certain antidepressants, such as duloxetine (Cymbalta) and venlafaxine (Effexor), can effectively manage neuropathic pain described as burning or tingling.
Anticonvulsants: Medications like gabapentin (Neurontin) and pregabalin (Lyrica) can control nerve pain.
Steroids: Corticosteroids like dexamethasone can reduce inflammation that contributes to bone or nerve pain.

Non-pharmacological approaches to pain relief

Many patients find relief by supplementing medication with integrative therapies. These should be discussed with your care team and can include:

Acupuncture: Some people find relief from pain and other side effects through acupuncture.
Massage therapy: Gentle massage can relieve tension and promote relaxation.
Relaxation and meditation: Techniques such as deep breathing, meditation, and guided imagery can help manage anxiety and distract from pain.
Physical therapy: Can help with movement and pain related to muscle weakness or stiffness.

Comparison of common pain management options during chemotherapy


Feature	Acetaminophen	NSAIDs (e.g., Ibuprofen)	Opioids (e.g., Morphine)	Adjuvants (e.g., Gabapentin)
Best For	Mild to moderate pain, fever	Mild to moderate pain, inflammation (usually avoided)	Moderate to severe pain	Neuropathic (nerve) pain
Side Effects	Liver and kidney strain at high doses	Bleeding, ulcers, kidney damage	Constipation, nausea, sedation, confusion	Dizziness, sedation, mood changes
Primary Precautions	Monitor liver/kidney function. Do not exceed maximum dose. May mask fever.	Generally avoid due to bleeding and kidney risks.	Close monitoring for side effects. Avoid for patients with history of misuse without specialist advice.	Dose must be carefully titrated. Watch for side effects.
Chemotherapy Impact	Should be used under doctor's guidance, especially with liver-toxic chemo drugs.	Risk is elevated with low platelet counts or kidney concerns.	Risk of certain interactions (e.g., methadone).	Effective for chemotherapy-induced peripheral neuropathy (CIPN).

Conclusion

Effective pain management is a vital component of cancer treatment and can significantly improve your quality of life. While options range from common OTC drugs like acetaminophen to more potent prescription opioids and targeted adjuvant therapies, the safest and most effective approach is always a personalized one. Communication with your oncology team is paramount to navigate the complexities of medication interactions and to make informed decisions about pain relief. By discussing your symptoms openly and honestly, you can find a combination of therapies that provides comfort and supports your overall treatment plan.

For more information on cancer pain management, consider visiting the American Society of Clinical Oncology (ASCO) at: https://ascopubs.org/doi/10.1200/JCO.22.02198

Frequently Asked Questions

You should generally avoid taking ibuprofen (Advil, Motrin) and other NSAIDs during chemotherapy. They can increase the risk of bleeding, especially if you have low platelet counts, and may cause kidney damage, which can be a concern with certain chemo drugs.

Yes, acetaminophen is generally considered safe for mild to moderate pain relief during chemotherapy, but it should be used under your doctor's guidance. Avoid high doses, as it can be toxic to the liver. Also, be aware that it can mask a fever, a key sign of infection.

Neuropathic pain is caused by nerve damage from chemotherapy and is often described as a burning or tingling sensation. It is typically treated with adjuvant medications such as certain antidepressants (e.g., duloxetine) or anticonvulsants (e.g., gabapentin), not standard painkillers.

Opioids are strong prescription medications used for moderate to severe cancer-related pain that isn't relieved by OTC drugs. Examples include morphine, oxycodone, and fentanyl. They are typically given on a regular schedule to keep pain under control.

If your platelet count is low, you should avoid NSAIDs and aspirin due to the increased risk of bleeding. Acetaminophen is a safer alternative, but your doctor must be aware of your counts when prescribing any medication.

Yes, many patients find integrative or complementary therapies helpful, including acupuncture, massage, and relaxation techniques. Always inform your oncologist before starting any new therapy to ensure it is safe for your specific condition.

Many medications, including some painkillers, are processed by the liver and kidneys. If these organs are already strained by chemotherapy, certain painkillers could cause further damage or lead to toxic levels accumulating in your body. Your doctor will adjust dosages or choose alternative medications based on your organ function.