Chronic pain is a serious health condition. Like any long-term health problem, the condition often leads to complications beyond your physical symptoms, such as new or worsened depression, anxiety, and difficulty sleeping. Chronic pain can make it more difficult to keep up at work, manage tasks at home and attend social gatherings, leading to problems in your relationships and financial instability. Some research suggests that the more severe your pain, the more serious these problems.
The serious consequences of chronic pain make finding effective treatment a critical goal. Unfortunately, this process is complex and uniquely personal. What works for one person's chronic low back pain may not offer any relief for your osteoarthritis, for a number of reasons. Your diagnosis, biology and personal history all play a role, and finding pain therapies that bring you adequate relief can be a lengthy effort.
Working in partnership with your doctor, however, you can identify treatments that allow you to live an enjoyable, fulfilling life. The approach you choose should include more than just medication, but painkillers are likely to play a role. Learn about the risks and benefits of common pain medications so that you can make safe choices as you seek your solution.
NSAIDs are most effective for mild to moderate pain that's accompanied by swelling and inflammation. These drugs are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps.
Acetaminophen is usually recommended as a first line treatment for mild to moderate pain, such as from a skin injury, headache or musculoskeletal condition. Acetaminophen is often prescribed to help manage osteoarthritis and back pain. It may also be combined with opioids to reduce the amount of opioid needed.
These medications were developed with the aim of reducing common side effects associated with traditional NSAIDs. COX-2 inhibitors are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps. They are as effective as NSAIDs and may be the right choice if you need long-term pain control without increased risk of stomach damage.
Benefits and risks. COX-1 enzymes help protect the lining of your stomach. NSAIDs, which block COX-1, can cause side effects such as stomach pain and bleeding. COX-2 inhibitors, on the other hand, help keep the stomach protected by acting only on COX-2 enzymes, allowing COX-1 to function normally.
Although the risk of stomach bleeding is generally lower if you take a COX-2 inhibitor instead of an NSAID, bleeding can still occur, especially at higher doses. These medications may cause side effects, such as headaches and dizziness, and can lead to kidney problems, fluid retention and high blood pressure.
Some medications commonly prescribed to manage depression and prevent epileptic seizures have also been found to help relieve chronic pain, including back pain, fibromyalgia and diabetes-related nerve pain (diabetic neuropathy). Because chronic pain often worsens depression, antidepressants may doubly benefit pain and mood symptoms.
Generic (brand) names. Tricyclic antidepressants used in the treatment of chronic pain include amitriptyline and nortriptyline (Pamelor).
Serotonin and norepinephrine reuptake inhibitors (SNRIs) that may be prescribed to relieve chronic pain include duloxetine (Cymbalta), venlafaxine (Effexor XR, Pristiq) and milnacipran (Fetzima, Savella).
Anti-seizure medications that are widely used for the treatment of chronic nerve pain, including postherpetic neuralgia and diabetic neuropathy, include gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica).
Opioid medications are synthetic cousins of opium and the drugs derived from opium, such as heroin and morphine. These drugs are often prescribed for acute pain that stems from traumatic injury, such as surgery or a broken bone. Opioids currently cause the most prescription drug-related overdose deaths in the United States — and that rate is still rising. Because the risks are so great, opioids are used at the lowest dose possible, usually for just a few days.
Benefits and risks. Research shows that over time, your body adapts to these medications, and they bring less and less pain relief. This phenomenon, known as tolerance, means that you need more of the same medication to achieve the same degree of pain relief. Long-term use of opioids may lead to dependence on these medications and, eventually, addiction.
The longer you use opioids, the greater your risk of becoming addicted. However, even using opioids to manage pain for more than a few days increases your risk. Researchers at Mayo Clinic have found that the odds you'll still be on opioids a year after starting a short course increase after only five days on opioids.
While there isn't a cure for chronic pain, many effective pain medications are available to help you function effectively and enjoy your days. As you try different drugs, alone or in combination, work with your doctor to target the simplest long-term solution possible. Keep your medication risks to a minimum to improve your odds of many good days, for many years to come.
|Medication type||How they work||First line option for||Benefits||Risks|
|NSAIDs||Block COX-1 and COX-2 enzymes involved in pain and inflammation||
||When taken as directed, generally safe for short- and long-term use||
|Acetaminophen||Unknown, but possibly blocks a COX-3 enzyme||Mild to moderate pain||Acetaminophen||Unknown, but possibly blocks a COX-3 enzyme|
|COX-2 inhibitors||Block COX-2 enzymes||Rheumatoid arthritis, osteoarthritis, menstrual cramps and injury-related pain||As effective as NSAIDs without damaging stomach lining at regular doses||
|Antidepressants||Interfere with certain chemical processes that cause you to feel pain||
|Anti-seizure medications||Quiet pain signals from damaged nerves||Postherpetic neuralgia, diabetic neuropathy, fibromyalgia||Side effects generally mild||
|Opioids||Activate feel-good neurotransmitters, called endorphins, that suppress pain and boost a sense of well-being||
||Powerful relief during short periods of severe pain||