Managing Chronic Pain: Medicines

Medicines can help you live better with chronic pain. You may use over-the-counter or prescription medicines. It can take some time and trial and error to work out the best treatment plan for you. Work with your healthcare provider to find the best medicines for you, and to use them safely and effectively.

A part of your treatment plan

Depending on the type of pain you have, you may take medicines:

• At times when pain is more intense than usual

• For pain relief throughout the day

• Before activities that tend to trigger pain, like going shopping or doing physical therapy

• To lower sensitivity to pain and help you sleep

Four major groups of medicines are used for the treatment of chronic pain. Each is described below.

Non-opioids

These include the commonly used medicine acetaminophen, as well as the non-steroidal anti-inflammatory medicines (NSAIDs) such as aspirin, ibuprofen, naproxen sodium, and ketoprofen. These all help control pain, but NSAIDs also help relieve inflammation. These medicines are available over the counter. Some NSAIDS are available by prescription only.

Acetaminophen can cause liver damage if you take more than the recommended dose. NSAIDs may cause stomach problems like bleeding ulcers. Using them over a long time can cause heart problems and stroke in a very small number of people. These medicines aren't addictive.

Opioids

This includes medicines such as morphine, oxycodone, codeine, fentanyl, and methadone. Opioids may be used to treat more severe types of pain. Opioids are available only by prescription. These medicines may also work to manage chronic pain, but they may be abused. They also have unpleasant and potentially very dangerous side effects.  

Adjuvants

This group includes medicines that were originally made to treat other conditions, but were also found to relieve pain. Examples of adjuvant medicines include antidepressants and anticonvulsants.

Antidepressants

These help pain by working on the same brain chemicals that play a role in depression. They also help improve sleep. Tricyclic antidepressants are one group of antidepressants used to treat chronic pain caused by nerve injury (neuropathic pain). Examples include amitriptyline, nortriptyline, and desipramine. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and milnacipran are also used.

Some types of antidepressants are used in low doses for sleep problems. They may also be prescribed if you are very sensitive to pain or have certain kinds of nerve pain.

Anticonvulsants were developed to prevent seizures. These medicines can help certain pain conditions, particularly nerve (neuropathic) pain. Examples include gabapentin and pregabalin.

Other pain medicines

• Topical. These medicines include lidocaine or capsaicin. They are put on the skin to treat pain in one place.

• Muscle relaxants. These may be used to stop painful muscle spasms. Medicines like cyclobenzaprine can make you drowsy.

Taking medicine safely

• Take your medicine on time and in the right dose as prescribed.

• Tell your healthcare provider if your medicine doesn't relieve your pain or work for a long enough time, or if you have side effects.

• Don't take other people's medicines. They may not be safe for you.

• Don't use alcohol, tobacco, or illegal drugs. These may interact with your medicines and cause you harm.