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Chronic pain is defined as pain persisting for more than three months. It is a complex condition, and depending on how it affects the body requires a varied treatment approach. Medications play a crucial role in managing chronic pain. They are classified into several categories based on how they work and what they treat. Here, PatientsLikeMe will provide an overview of the drug classifications used to treat chronic pain.
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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are commonly used to relieve pain, reduce inflammation, and bring down a high temperature. If you are experiencing a headache, sprain, painful period, or a condition like arthritis, you may turn to an NSAID for relief. They are available as tablets or capsules, creams, gels and injections. Some can be bought over the counter, while others require a prescription. Some examples are:
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Diclofenac (Voltarol)
- Celecoxib (Celebrex)
Like all medicines, NSAIDs do have some side effects. Indigestion or stomach ulcers can arise, as well as headaches, drowsiness, or allergic reactions.
Acetaminophen
Acetaminophen is one of the most common active drug ingredients in the US. It is often used to relieve mild to moderate pain from headaches, muscle aches, colds and sore throats, and to reduce a fever. People with a history of stomach problems, who are over the age of 60, have kidney disease, or who are on aspirin heart therapy often turn to acetaminophen. Here are commonly prescribed drugs with this active ingredient:
- Hydrocodone (Vicodin, Norco)
- Oxycodone (Percoset, Endocet)
- Codeine (Tylenol with Codeine)
- Butalbital (Fioricet)
Acetaminophen can cause severe skin reactions, or liver damage if taking more than 4,000 mg in 24 hours. You may also experience nausea, stomach cramps, or pain in the abdomen.
Opioids
Opioid medications are synthetic cousins to opium and drugs derived from it. These are usually prescribed to treat acute pain, which is newly occurring pain from an injury. They can, however, be used for chronic pain. Prescription options include:
- Hydrocodone (Vicodin, Lortab)
- Oxycodone (OxyContin)
- Morphine (MS Contin, Kadian)
- Hydromorphone (Dilaudid)
Opioids are highly addictive, and have led to a surge in overdose deaths worldwide. They are often considered a last resort for chronic pain management. They should be taken with caution, and in close collaboration with your healthcare provider.
Antidepressants and Anticonvulsants
Some medications used to treat depression and prevent epileptic seizures have been found to help relieve chronic pain. Antidepressants are used even when depression is not a factor. They work best for pain caused by arthritis, nerve damage, migraines, and lower back and pelvic problems. Some commonly prescribed versions are:
Antidepressants
- Amitriphtyline (Elavil)
- Nortripyline (Pamelor)
- Duloxetine (Cymbalta)
- Doxepin (Silenor)
- Protriptyline (Vivactil)
Anticonvulsants
- Gabapentin (Gralise, Neurontin)
- Pregabalin (Lyrica)
Some antidepressants may cause blurred vision, drowsiness, nausea, and weight gain. Doctors will usually start you on a low dose and slowly increase the amount over time. Side effects from anticonvulsants are common when starting. They can also cause nausea, as well as dizziness, sleepiness, and mood changes. These side effects are usually not serious, but be sure to talk to your doctor if you have any concerns.
COX-2 Inhibitors
COX-2 inhibitors are another type of NSAID. Often referred to as selective NSAIDs, they treat pain and inflammation of many types of arthritis, as well as other types of short-term pain. There are two types of COX enzymes within the body. Both produce prostaglandins, which cause inflammation, pain, and fever. NSAIDs treat both COX-1 and COX-2, while COX-2 inhibitors only target the one. They are generally more effective at preventing inflammation. Some examples are:
- Celecoxib (Celebrex)
- Valdecoxib (Bextra)
- Rofecoxib (Vioxx)
COX-2 inhibitors may increase the risk of heart attacks and strokes. They can also lead to stomach and intestinal problems. Doctors recommend you avoid these drugs if you have a history of stroke, severe kidney problems or liver failure, or an upcoming surgery.
Choosing the right medication for chronic pain depends on the type, severity, and underlying cause of the pain! While these medications can provide relief, they also come with risks and side effects. Work closely with your doctor to find the right treatment for you.