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. To avoid dangerous drug interactions, tell your doctor all the medicines you are taking (including herbal and other complementary medicines).

Medication choices

You will likely be given medicines that cause the fewest side effects first (such as acetaminophen) to treat chronic pain. The dose will be increased or the medicines will be changed as needed. Medicines used to treat chronic pain include the following:

• Acetaminophen, such as Tylenol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, for example), ketoprofen, and naproxen (Aleve, for example). Always take NSAIDs exactly as prescribed or according to the label. Do not take a nonprescription NSAID for longer than 10 days without talking to your doctor.
• Tricyclic antidepressants, such as amitriptyline.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
• Corticosteroids, such as prednisone. Sometimes, steroids are injected around the base of the spine to relieve low back pain (epidural steroid injections).
• Oral medicines that act like a local anesthetic, such as mexiletine.
• Anticonvulsants, such as gabapentin (Neurontin) and pregabalin (Lyrica).
• Pain relievers that are applied directly to the skin (topical analgesics), such as EMLA cream or a lidocaine patch (Lidoderm).
• Capsaicin, a naturally occurring substance that is found in chili peppers and is used to make certain topical analgesic creams.
• Cooling spray. This involves using a cooling spray (such as Biofreeze) directly on the skin. This may be repeated several times.
• Creams or gels containing medicines or combinations of medicines. The cream or gel is rubbed directly on the painful area. Some of these creams or gels can be made at the pharmacy according to your doctor's directions.
• Opiate pain relievers, such as hydrocodone (such as Vicodin).

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 work for everyone.
• Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) linked to chronic fascial pain or fibromyalgia. 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. But 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.

If you take opiate pain relievers for longer than a week or so, they can cause your body to keep expecting the medicine. This is called drug dependency. Over time, you may need more of the drug to get the same effects. This is called tolerance. This is not the same as addiction.

You may become physically dependent on opiate pain relievers if you take them regularly. Physical dependence is not addiction, but it is a gradual change in your body in response to the opiates. If you stop taking opiate pain relievers abruptly, you may develop nausea, sweating, chills, diarrhea, and shaking. The physical dependence and withdrawal symptoms are not life-threatening. You can avoid withdrawal symptoms if you gradually stop taking the opiates over a set period of time, as prescribed by your doctor.