Medications
Medicines can often help control chronic pain. Many different drugs, both prescription and nonprescription, are used to treat chronic pain. All these medicines can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before medicines work to reduce pain. It is important to let your health professional know all medicines you are taking (including herbal and other complementary medicines) to avoid dangerous drug interactions.
Medication Choices
You will likely be given medicines that cause the least significant side effects first (such as acetaminophen) to treat chronic pain. The dose will be increased or the medicines will be changed as needed. Older adults are more likely to experience adverse side effects, so medicines may be started at even lower doses and increased more slowly. Medicines used to treat chronic pain include the following:
- Pain relievers (analgesics)—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (for example, Motrin)—which may be prescribed for mild to moderate pain and to reduce inflammation. Always take these medicines exactly as prescribed or according to the label. Do not take a nonprescription NSAID for longer than 10 days without talking to your doctor.
- Antidepressants, such as tricyclic antidepressants (for example amitriptyline), which may be used to treat chronic pain, although not all antidepressants are effective at reducing pain. Duloxetine (Cymbalta) is another type of antidepressant that is approved by the U.S. Food and Drug Administration to treat pain from peripheral neuropathy.
- Corticosteroids, such as prednisone, which are used to reduce inflammation and pain.
- Oral medicines, such as mexiletine (Mexitil), that act like a local anesthetic to dull pain.
- Anticonvulsants, which may ease pain that starts in the nerves (neuropathic pain). Examples are:
- Gabapentin (Neurontin) for postherpetic neuralgia (nerve pain from shingles).
- Pregabalin (Lyrica) for postherpetic neuralgia and diabetic neuropathy (nerve pain from diabetes).
- Carbamazepine (Tegretol) to help control the episodes of facial pain in trigeminal neuralgia. If you take carbamazepine daily, you should be checked periodically to be sure you don’t develop serious side effects (such as an allergic reaction or liver problems).
- Pain relievers that are applied directly to the skin (topical analgesics), such as EMLA cream or a lidocaine patch (Lidoderm), which can numb the skin and decrease pain.
- Capsaicin, a naturally occurring substance that is found in chili peppers and is used to make certain topical analgesic creams. Capsaicin changes the pain signals in the skin, blocking pain without blocking other sensations. Capsaicin may cause a burning sensation when it is first applied. Always wear gloves when applying capsaicin and do not touch or rub your eyes until you have washed your hands.
- Opioid analgesics, which may relieve moderate to severe pain. Examples of opioids include morphine, oxycodone (such as OxyContin), hydrocodone with acetaminophen (such as Vicodin, Lortab, or Norco), or acetaminophen with codeine (such as Tylenol with codeine). Opioids are sometimes combined with other medicine, such as gabapentin, for nerve pain.
Other therapies that may be used to treat chronic pain include:
- Nerve block injections. An anesthetic is injected into the affected nerve to relieve pain. The anesthetic may relieve pain for several days, but the pain often returns. Although nerve blocks do not normally cure chronic pain, they may allow you to begin physical therapy and improve your range of motion.
- Epidural steroid injections (injecting steroids around the spine). Although these injections have been used for many years and may provide relief for low back or neck pain caused by disc disease or pinched nerves, they may not be effective for everyone.
- Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) associated with chronic facial pain or fibromyalgia. For many people, nerve blocks or other injections can relieve chronic pain for good. However, it is not completely clear how this type of treatment works. These injections do not relieve chronic pain in everyone.
What To Think About
Medicine may work best when it is used in combination with other types of treatment, such as physical therapy and counseling, to address the different causes of chronic pain. Each person tolerates and responds to medicines differently.
Medicines can reduce or provide temporary relief of chronic pain. At first, you may be given medicines that cause the fewest side effects. Then, if needed, the dose will slowly be increased or you will be switched to a different medicine.
In general, avoid drinking alcohol while taking pain medicines, and do not take higher doses of any medicine than your doctor prescribed.
Daily medicines can be an effective part of long-term treatment for chronic pain. However, sometimes a medicine loses some or all of its effectiveness when it is used daily over a long period of time, because your body develops a tolerance to it.
