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 pain that comes and goes.
About 1 in 12 adults in the United States have high-impact chronic pain. Healthy People 2030 focuses on helping people with high-impact chronic pain safely manage their pain and reduce its impact. Chronic pain can last for weeks, months, or even years. It’s linked to anxiety and depression, and it can limit people’s ability to work or do other activities. It’s also one of the most common reasons people see a health care provider. Strategies to help people manage chronic pain include physical therapy and interventions to increase physical activity.
Both non-opioid and opioid medications are also used to treat chronic pain. People who take opioids are at risk for many adverse effects, including opioid misuse. Improving opioid prescribing practices, increasing safe disposal of unused opioids, and increasing the use of non-opioid medications can help reduce opioid misuse.
While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap — sprained back, serious infection, or there may be an ongoing cause of pain — arthritis, cancer, ear infection, but some people suffer chronic pain in the absence of any past injury or evidence of body damage.
Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system). A person may have two or more co-existing chronic pain conditions.
Such conditions can include chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.
What drugs can treat chronic pain?
Medications, acupuncture, local electrical stimulation, and brain stimulation, as well as surgery, are some treatments for chronic pain. Some physicians use placebos, which in some cases has resulted in a lessening or elimination of pain. Psychotherapy, relaxation and medication therapies, biofeedback, and behavior modification may also be employed to treat chronic pain.
Many medicines can decrease pain, including the ones listed below. Each one may have side effects. Some side effects can be serious. It’s important to listen to your family doctor carefully when he or she tells you how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your doctor or your pharmacist.
Acetaminophen (one brand name: Tylenol) helps many kinds of chronic pain. Remember, many over-the-counter and prescription pain medicines have acetaminophen in them. If you’re not careful, you could take more acetaminophen than is good for you. Taking too much acetaminophen could cause liver damage, especially if you drink alcohol. If you often find that you have to take more than 2 acetaminophen pills a day, tell your doctor.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Other drugs that help with pain are called nonsteroidal anti-inflammatory drugs, or NSAIDs. Examples include aspirin, ibuprofen (two brand names: Motrin, Advil) and naproxen (one brand name: Aleve). NSAIDs come in both over-the-counter and prescription forms. These medicines can be taken just when you need them, or they can be taken every day. When these medicines are taken regularly, they build up in the blood to levels that fight the pain of inflammation (swelling) and also give general pain relief.
If your doctor wants you to take an NSAID, always take it with food or milk because the most common side effects are related to the stomach. They can also cause increased bruising or risk of bleeding in the stomach. When taken for long periods of time, they may cause kidney damage. NSAIDs may make high blood pressure worse or interfere with blood pressure medicines.
Narcotics can be addictive, so your family doctor will be careful about prescribing them. For many people who have severe chronic pain, these drugs are an important part of their therapy. If your doctor prescribes narcotics for your pain, be sure to carefully follow his or her directions. Tell your doctor if you are uncomfortable with the changes that may go along with taking these medicines, such as the inability to concentrate or think clearly. Do not drive or operate heavy machinery when taking these medicines.
When you’re taking narcotics, it’s important to remember that there is a difference between “physical dependence” and “psychological addiction.” Physical dependence on a medicine means that your body gets used to that medicine and needs it in order to work properly. When you don’t have to take the pain medicine any longer, your doctor can help you slowly and safely decrease the amount of medicine until your body no longer “needs” it.
Psychological addiction is the desire to use a drug whether or not it’s needed to relieve pain. Using a narcotic this way can be dangerous and may not help your pain. If you have a psychological addiction to a narcotic, your doctor may give you another drug to help with your psychological problems. Or your doctor might recommend that you talk to a counselor. Your doctor might also change the medicine that you are addicted to by lowering the dose, changing to another drug or stopping the medicine altogether.
Narcotic drugs often cause constipation (difficulty having bowel movements). If you are taking a narcotic medicine, it’s important to drink at least 6 to 8 glasses of water every day. Try to eat 2 to 4 servings of fresh fruits and 3 to 5 servings of vegetables every day. Be sure to tell your doctor if constipation becomes a problem for you. He or she may suggest taking laxatives to treat or prevent it.
Many drugs that are used to treat other illnesses can also treat pain. For example, carbamazepine is a seizure medicine that can also treat some kinds of pain. Amitriptyline is an antidepressant that can also help with chronic pain. Your doctor may want you to try one of these medicines to help control your pain. It can take several weeks before these medicines begin to work well.
Remember — if you are taking any pain medicine, be sure to ask your doctor or pharmacist before you take any other medicine, either prescription or over-the-counter. You should also check with your doctor or pharmacist before taking an herbal supplement or vitamin.
Types (classes) of pain medication
Pain medications are drugs used to relieve discomfort associated with disease, injury, or surgery. Because the pain process is complex, there are many types of pain drugs that provide relief by acting through a variety of physiological mechanisms. Thus, effective medication for nerve pain will likely have a different mechanism of action than arthritis pain medication.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) act on substances in the body that can cause inflammation, pain, and fever.
- Corticosteroids are often administered as an injection at the site of musculoskeletal injuries. They exert powerful anti-inflammatory effects. They can also be taken orally to relieve pain from, for example, arthritis.
- Acetaminophen increases the body’s pain threshold, but it has little effect on inflammation.
- Opioids, also known as narcotic analgesics, modify pain messages in the brain.
- Muscle relaxants reduce pain from tense muscle groups, most likely through sedative action in the central nervous system.
- Anti-anxiety drugs work on pain in three ways: they reduce anxiety, they relax muscles, and they help patients cope with discomfort.
- Some antidepressants, particularly the tricyclics, may reduce pain transmission through the spinal cord.
- Some anticonvulsant drugs also relieve the pain of neuropathies, possibly by stabilizing nerve cells.