Pain Medications

Pain medicines, whether they’re over-the-counter or prescription strength, can help you manage chronic pain and other kinds of pain. They’re powerful drugs, so it's important to use them with care. It’s best to start with the safest drugs at the lowest effective dose for the shortest amount of time and work up from there as needed.

Be aware of possible side effects and interactions with other drugs and supplements you take. And always follow the directions on the label or your doctor’s prescription.

Over-the-Counter Pain Relievers

Over-the-counter (OTC) pain relievers include:

• Acetaminophen (Tylenol)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and diclofenac gel

Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling, heat, redness related to an injury, and irritation). Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain and inflammation. Acetaminophen works on the parts of the brain that receive the "pain messages." NSAIDs are also available in a prescription strength that can be prescribed by your doctor.

Using NSAIDs regularly, especially at high doses, increases the risk of heart attacks and strokes and can also cause stomach ulcers and bleeding. They can also cause kidney problems. Taking acetaminophen regularly at high doses can cause a liver problem. Taking a large amount at once intentionally or accidentally is a medical emergency.

Topical pain relievers are also available without a doctor's prescription. These products include creams, lotions, or sprays that are applied to the skin in order to relieve pain from sore muscles and arthritis. Some examples of topical pain relievers include Aspercreme, BenGay, capsaicin cream, diclofenac gel, and Icy Hot.

What Are Corticosteroids?

Prescription corticosteroids provide relief for inflamed areas of the body by easing swelling, redness, itching, and allergic reactions. Corticosteroids can be used to treat allergies, asthma, and arthritis. When used to control pain, they are generally given in the form of pills or injections that target a certain joint. Examples include methylprednisolone, prednisolone, and prednisone.

Prescription corticosteroids are strong medicines and may have serious side effects, including:

• Weight gain and salt retention
• Peptic ulcer disease
• Mood changes
• Trouble sleeping
• Weakened immune system
• Thinning of the bones and skin
• High sugar levels

To minimize these potential side effects, corticosteroids are prescribed in the lowest dose possible for as short of a length of time as needed to relieve the pain. Another way to minimize these side effects is to give the steroid by injection to target the particular problem area.

What Are Opioids?

Opioids are narcotic pain medications that contain natural, synthetic, or semi- synthetic opiates. Opioids are often used for acute pain, such as short-term pain after surgery. Some examples of opioids include:

• Codeine
• Fentanyl
• Hydrocodone-acetaminophen
• Morphine
• Oxycodone
• Oxycodone-acetaminophen

Opioids are effective for severe pain and do not cause bleeding in the stomach or other parts of the body, as can some other types of pain relievers. However, they can be extremely addictive, and doctors will try to find alternatives to prescribing them. It’s rare for people to become addicted to opioids if the drugs are used to treat pain for a short period of time. But if used to treat chronic pain, the risk of addiction is real and potentially dangerous.

Side effects of opioids may include:

• Drowsiness
• Nausea and vomiting
• Constipation
• Itching
• Breathing problems
• Addiction

What Are Antidepressants?

Antidepressants are drugs that can treat pain and emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. These medications can increase the availability of the body's signals for well- being and relaxation, enabling pain control for some people with chronic pain conditions that do not completely respond to usual treatments. Research suggests certain antidepressants (tricyclics) work best for neuropathic or nerve pain.

Chronic pain conditions treated by low-dose antidepressants include some types of headaches (like migraines) and menstrual pain. Some antidepressant medications include:

• Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
• Tricyclic antidepressants such as amitriptyline, desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), and nortriptyline (Pamelor)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) and venlafaxine (Effexor)

These drugs require a steady dose of the medicine buildup in the body over a period of time to work. The doses needed to treat pain are often lower than those needed to treat depression.

Generally, SSRIs and SNRIs have fewer side effects than tricyclic antidepressants. The most common side effects with antidepressants include:

• Blurry vision
• Constipation
• Difficulty urinating
• Dry mouth
• Fatigue
• Nausea
• Headache
• Sexual dysfunction

What Are Anticonvulsants?

Anticonvulsants are drugs typically used to treat seizure disorders. Some of these medications are effective in treating pain as well. The exact way in which these medicines control pain is unclear, but it is thought that they minimize the effects of nerves that sense pain. Some examples include carbamazepine (Tegretol), gabapentin (Neurontin), pregabalin (Lyrica), and topiramate (Topamax).

In general, anticonvulsants are well tolerated. The most common side effects include:

• Drowsiness
• Dizziness
• Fatigue
• Nausea

Other Pain Treatments

Another means of topical pain relief comes in the form of a lidocaine (Lidoderm) patch, which is a prescription medication.

Muscle relaxers work by depressing the central nervous system, helping relieve muscle tension and spasm and often causing drowsiness. They can be effective for short-term use for acute flare-ups of back pain and nerve pain. They can also help treat nighttime muscle pain from fibromyalgia.

If your pain is not relieved by the usual treatments, your doctor may refer you to a pain management specialist. Doctors who specialize in pain management may try other treatments such as certain types of physical therapy or other kinds of medicine. They may also recommend TENS, a procedure that uses patches placed on the skin to send signals that may help stop pain.

Spinal cord stimulation (SCS) involves surgery to fully or partially implant a small device somewhat like a pacemaker in the epidural space adjacent to the area of the spine which is believed to be the source of the pain. It sends mild electric pulses through leads to help mask and interrupt the pain signals to your brain.

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