Medications for Chronic Pain

Acetaminophen, NSAIDs, Opioids, and Other Medications

When it comes to treating chronic pain, medications play a crucial role. There are numerous medications available to help you manage pain. However, every pain patient is different and responds to medications differently. Some people may need to take prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs) daily, while others may need something more potent, such as an opioid.

Over-the-counter medications, such as aspirin, acetaminophen, or ibuprofen, may not be strong enough. The majority of chronic pain patients need prescription medications to cope with pain. Note that many prescription medications may contain acetaminophen or ibuprofen, so tell your doctor if you take over the counter versions of these medications.

Although there are many types and brands of medications, what medication your doctor prescribes depends on you—your pain level, treatment goals, and overall health.

This printable Smart Patient's guide features a detailed look at some of the non-opioid medications available for managing a variety of chronic pain conditions, including NSAIDS, antidepressants, and more:

Before taking any medication, even if it's an over-the-counter medication, discuss the medication with your doctor. Some medications have serious side effects if they're not taken as directed. Also, make sure you tell your doctor about everything you're taking, including herbal remedies and supplements, because of possible drug interactions or side effects.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs are a type of analgesic (a painkiller or pain reliever) but they also help fight inflammation.

They're similar to steroids because they work on the body's inflammatory response. However, NSAIDs do this without using steroids. If taken long-term, steroids have side effects, such as weight gain and osteoporosis Your body also gets used to the steroids, so you have to gradually stop taking them.

Osteoarthritis, rheumatoid arthritis, and headaches, are common conditions that NSAIDs treat.

COX-2 inhibitors are a newer class of prescription-strength NSAIDs. Examples of COX-2 inhibitors are celecoxib (Celebrex) and meloxicam (Mobic).

In July 2015, the FDA strengthened existing warnings in prescription drug labels and over-the-counter (OTC) Drug Facts labels to indicate that NSAIDs can increase the chance of a heart attack or stroke, either of which can lead to death. Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs. (Although aspirin is also an NSAID, this revised warning doesn’t apply to aspirin.)

In the most extreme pain cases, your doctor can prescribe you an opioid, but you'll need to be under your doctor's careful supervision when taking this medication.

Opioids—also called narcotics—are potent painkillers. They provide immediate relief to intense pain by changing your brain's perception of the pain message. However, opioids are typically prescribed only if other medication options aren't successful. They may be prescribed for low back pain, neuropathic pain, or arthritis pain, for example. Examples of opioids are oxycodone (Endocet), tramadol (Ultram), and morphine.

Other Medications for Chronic Pain 

There are many other medications that can help control chronic pain and other symptoms. Below is a list of some of these medications.

If your doctor prescribes an anti-depressant, that doesn't mean you're depressed. Anti-depressants are used for other reasons, too. In fact, they help control pain by changing your body's chemicals. Anti-depressants can treat chronic pain associated with diabetic neuropathy, fibromyalgia, neck pain, and low back pain. There are 3 categories of anti-depressants: tricyclic anti-depressants (TCAs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and selective serotonin reuptake inhibitors (SSRIs). TCAs, SNRIs, and SSRIs each work in a different way.

TCAs raise the level of certain neurotransmitters—chemicals messengers—while SNRIs change the re-absorption of neurotransmitters in the body. However, even though SSRIs are sometimes prescribed, they don't work well for chronic pain. In fact, a February 2019 study found that SSRI antidepressants were shown to dampen the effects of prodrug opioids such as hydrocodone, resulting in less effective pain management.

Examples of TCAs are amitriptyline hydrochloride (Elavil) and nortriptyline (Pamelor). Examples of SNRIs are duloxetine (eg, Cymbalta) and venlafaxine (Effexor). Examples of SSRIs are hydrochloride (Prozac) and sertraline paroxetine (Zoloft).

Anti-seizure Medications
Also known as anti-convulsants or anti-epileptics, anti-seizure medications work to suppress the nerve signals going to your brain so pain messages aren't transmitted as well. As with anti-depressants, if your doctor prescribes an anti-seizure medication, that doesn't mean he or she is treating you for seizures. Anti-seizure medications can treat chronic pain caused by diabetic neuropathy and fibromyalgia. Examples of anti-seizure medications are pregabalin (Lyrica) and gabapentin (eg, Gabarone).

Steroids are powerful anti-inflammatory medications that can be taken orally or injected. If prescription-strength NSAIDs haven't reduced your pain, your doctor may recommend that you try corticosteroids. They're responsible for stopping your body from producing the chemical that causes inflammation.

However, as mentioned above, steroids have certain side effects (eg, weight gain), and you can't just stop taking them—your dose must be slowly decreased. Corticosteroids are used to treat migraines, osteoarthritis, rheumatoid arthritis, and low back pain. Prednisone (Deltasone) and Decadron (Dexamethasone) are examples of corticosteroids.

Muscle Relaxants
These medications are used to reduce aches and pains associated with muscles strains, sprains, or spasms. Muscle relaxants can provide the pain relief you need to manage your daily activities by helping relax tight muscles and improve the quality of sleep you get. Muscle relaxants aren't typically recommended for treating chronic pain, but they may help with fibromyalgia and low back pain symptoms. Examples of muscle relaxants are carisoprodol (Soma) and baclofen (Lioresal).

Topical Medications
Some medications are highly effective when used topically. Also known as topical analgesics, topical medications, such as a lidocaine patch (Lidoderm) can help you manage pain caused by diabetic neuropathy, osteoarthritis, and low back pain. Another example is capsaicin cream. Capsaicin, which comes from chili peppers, can temporarily reduce pain, but for maximum benefits, it needs to be applied several times a day for about 6 weeks.

Your Treatment Plan
The most important thing to remember when taking medications to treat your chronic pain is that you need to be an active participant in your own treatment plan. Don't be afraid to ask questions—you have to be your own advocate. Over time, you may need to increase or decrease your dose of medication or perhaps change medications, so it's essential that you carefully follow your doctor's directions. Also, be on the lookout for side effects. If you notice any new symptoms, tell your doctor immediately. But don't stop taking your medication unless your doctor tells you to do so.

Updated on: 06/16/21
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