Chronic Pain Medicines

Chronic pain is a type of pain that continues over time. It can last anywhere from 3 months or more to several years. Chronic pain may be caused by certain health conditions. It is more common in people who are older.

Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants, and anticonvulsants. Different types of medicines help people who have different types of pain. You usually use long-acting medicines for constant pain. Short-acting medicines treat short-term, or acute, pain.

Path to improved health

The goal of chronic pain treatment is to increase function and quality of life. Different types of medicines help people who have different types of pain. For instance, short-acting medicines treat pain that comes and goes. Long-acting medicines treat constant pain.

The most common medicines are listed below. Each one has side effects. These can range from mild to severe. It’s important to follow your doctor’s orders on how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your doctor or pharmacist.

Acetaminophen

Acetaminophen helps many kinds of chronic pain. One brand name is Tylenol. It is also found in many and prescription and over-the-counter pain medicines. If you’re not careful, you could take more acetaminophen than is good for you. Too much acetaminophen can cause liver damage, especially if you drink alcohol. Tell your doctor if you take more than 2 acetaminophen pills a day.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Other drugs that help with pain are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include aspirin, ibuprofen (two brand names: Motrin, Advil), and naproxen (one brand name: Aleve). NSAIDs come in both prescription and over-the-counter forms. These medicines can be taken sometimes or every day. When taken regularly, they build up in the blood to fight inflammation (swelling) and give general pain relief.

Always take NSAIDs with food or milk because the most common side effects are related to the stomach. Other side effects include:

• Increased bruising
• Risk of bleeding in the stomach
• Kidney damage (when taken for long periods of time)
• High blood pressure
• Interference with blood pressure medicines

If you take other pain medicines, do not take NSAIDs without talking to your doctor first.

Antidepressants

Many drugs that treat other illnesses can also treat chronic pain. For example, antidepressants can improve function and provide pain relief. Antidepressants may be used to treat nerve damage, arthritis, and fibromyalgia. They also may help with headaches, facial pain, low back pain, and pelvic pain. It can take several weeks for the medicines to start working.

Types of antidepressants your doctor may prescribe include:

• Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor), and doxepin.
• Selective serotonin/norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Possible side effects of antidepressants include:

• Nausea
• Drowsiness
• Insomnia (trouble sleeping)
• Dry mouth
• Dizziness
• Constipation
• Weight gain
• Heart problems

TCAs tend to have more side effects than SNRIs or SSRIs, but they usually are mild. Your doctor may start you on a low dose of medicine. This helps prevent side effects and allows your body to adjust. The doctor may increase the amount over time. If at any point while taking medicine you become depressed or have suicidal thoughts, call your doctor right away.

Anticonvulsants

Your doctor may want you to try an anticonvulsant medicine. It may help reduce some types of chronic pain, such as low back pain or nerve damage. Examples of anticonvulsants are:

• Gabapentin (Neurontin)
• Carbamazepine (Tegretol)
• Phenytoin (Dilantin)
• Pregabalin (Lyrica)
• Topiramate (Topamax)

Like antidepressants, your doctor may start you on a low dose of anticonvulsants. This helps prevent or reduce side effects. The doctor may increase the amount over time. Contact your doctor right away if you have suicidal thoughts. Minor side effects may include:

• Drowsiness
• Nausea or vomiting
• Restlessness
• Dizziness
• Loss of appetite
• Weight gain
• Itching or swelling

Narcotics

Doctors rarely prescribe narcotics or opioids to treat chronic pain. This is because they are highly addictive. Currently, there is an opioid crisis in the United States. People who become addicted can develop severe symptoms, such as increased pain, depression, or suicidal thoughts. They may begin to abuse other substances, or their behaviors could become harmful or violent. Addicts are at risk of misusing or overdosing on narcotics, which can cause death. Talk to your doctor about all risks of narcotics before starting a new medicine.

If your doctor does prescribe a narcotic, be sure to follow their directions. Do not drive or operate heavy machinery when taking narcotics. Do not use alcohol. Tell your doctor if you have side effects from narcotics. These may include nausea, constipation, and trouble focusing or thinking clearly. Your doctor can prescribe an anti-nausea drug or laxative to help with side effects.

When you’re taking narcotics, it’s important to remember the difference between physical dependence and psychological addiction. Physical dependence means that your body adjusts to a medicine and needs it to function. When you function has improved, your doctor will help you slowly and safely decrease the amount of medicine. Doing this helps prevent or reduce symptoms of withdrawal. It is critical to tell your doctor about these symptoms and work through the process together.

Psychological addiction is the desire to use a drug whether or not it’s needed to improve function and relieve pain. Using a narcotic this way is harmful to your health. Talk to your doctor if you think you are addicted to narcotics. They may give you other medicines to help your addiction. They could lower the dose, change to another drug, or stop the medicine. They may recommend counseling or rehab as well.

Things to consider

Always tell your doctor what other drugs you take. This includes medicines, vitamins, and supplements. The doctor also should know about all ongoing health conditions. Some medicines may not be safe to take. Do not start a new drug without your doctor’s approval.

It is important to follow instructions when taking chronic pain medicines. Some side effects can be harmful and cause other health concerns. They can also be harmful to your lifestyle if you develop a problem. Do not stop taking a drug without your doctor’s approval.

People who take medicine for chronic pain should have regular check-ups with their doctor. Contact your doctor right away if you have severe or abnormal side effects. This includes if you have an unplanned reaction. The doctor will tell you what you should do. Seek help if you think you are dependent on or addicted to a drug.

Questions for your doctor

• What are my options to treat chronic pain?
• What medicine(s) do I need to take?
• How long do I need to take them?
• How much and how often do I take the medicine?
• Do I need to take the medicine with anything or avoid things when I take the medicine?
• What are the possible side effects? What should I do if I have them?
• How do I safely start and stop chronic pain medicines?
• Are there alternative forms of treatment, besides medicine, that can treat chronic pain?

Resources

American Academy of Family Physicians: Chronic Pain

American Academy of Family Physicians: Opioid Addiction