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 health care provider to find the best medicines for you, and to use them safely and effectively.

Tell your health care provider about all medicines you`re taking, including herbs and vitamins.

A part of your treatment plan

Depending on your situation and the type of pain, 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 decrease sensitivity to pain and help you sleep.

There are 4 major groupings of medicines for the treatment of chronic pain:

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

Acetaminophen can cause liver damage if taken above the recommended dose. NSAIDs may cause stomach problems like bleeding ulcers. Using them over the long-term can cause heart problems and stroke in a very small number of people. None of these drugs is addictive.

Opioids. This includes drugs, like morphine, oxycodone, codeine, fentanyl, and methadone. Opioids may be used to treat breakthrough pain or severe chronic pain. Opioids are available only by prescription. These medicines may be effective for managing chronic pain. But they are controversial because of their side effects and because they can be addictive.  

Adjuvants. This group includes medicines that were originally made to treat other conditions, but were also found to relieve pain. Examples of adjuvant drugs 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 1 group of antidepressants used for treating chronic pain caused by nerve injury (neuropathic pain). Examples include amitriptyline, nortriptyline, and desipramine. Serotonin-norepinephrine reuptake inhibitors (SNRIs), like 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 some kinds of nerve pain.

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

Other pain medicines

  • Topical. These medicines, like lidocaine or capsaicin, are applied to the skin to treat pain in one location.

  • Muscle relaxants. These may be used to stop painful muscle spasms. Drugs like cyclobenzaprine can be sedating.

Taking medicine safely

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

  • Tell your health care professional 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.

  • Avoid alcohol, tobacco, and illegal drugs. These may interact with your medicines causing you harm.



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