“There are many different pain medicines, and each one has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.”
Prescription medicines need to be discussed with your doctor and together you will decide whether and which medicines may be appropriate.
Over-the-counter (OTC) meds
Acetaminophen (Tylenol), NSAIDs (ibuprofen, naproxen) are some of the most common OTC medications to treat moderate pain. These medications are generally safe, but may require lower doses in a day if you have liver or kidney disease. Please discuss with your doctor what dose and for what duration is safe for you.
Nonopioid medications
These medications target pathways different from the opioid pathway.
- Some medications are preferred for somatic pain (such as acetaminophen), or for arthritic pain (such as ibuprofen). Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) can be purchased over-the-counter and are some of the safest pain relievers available. For people without liver conditions, up to 3 g a day of acetaminophen is generally safe. For people without kidney conditions, up to 2400 mg is generally safe for a few weeks.
- Neuropathic pain can be treated with medications that calm nerve inflammation or disrupt the transmission of the nerve pain. Some examples include gabapentinoids, serotonin norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA). These neuropathic agents all work on different receptors in the brain, spinal cord, or in the nerve endings. Neuropathic pain medications can modify the central nervous system’s interpretation of pain. This can be a slow response, so some medications will require uptitration with your doctor.
- Muscle relaxers can be helpful for short term pain relief in an acute sprain or post-surgery, but are not recommended for long term use. Most muscle relaxers cause sedation in order to relax the muscles. Most muscle relaxers are not addictive, but should be carefully discussed with your doctor if you are greater than 65 years of age, or if you have kidney or liver problems.
- Topical agents (creams, gels, patches) can be compounded from any of the above agents. The most common contain NSAIDs such as diclofenac, lidocaine which is a local anesthetic such as the one you get at the dentist, or capsaicin the active ingredient in spicy peppers. Topicals work best when rubbed deeply into the painful area and can work on both somatic and neuropathic pain. Topicals are safe, and generally available for low costs over-the-counter. The downside is the frequency that each medication must be reapplied due to sweating, showering, etc. Skin changes can occur, please see the package insert or speak to your doctor before applying.
Opioid Medications
These medications are useful in the treatment of surgical pain. In addition to treating pain, they cause side effects such as drowsiness, constipation, and decreasing the drive to breathe. They are not recommended for long-term treatment of pain because a physical dependence can develop, and a tolerance to the medication that causes higher and higher opioid requirements.
Multimodal Analgesia
- Multimodal analgesia focuses on treating pain with both opioid and nonopioid medications in order to avoid the harmful side effects of opioids, both short-term and long-term
- Multimodal analgesia is safe, and can be offered in different routes and doses
- It is increasingly recognized that non-opioid analgesia is as effective as some opioid analgesia and that multimodal analgesia is better than exclusive opioid analgesia.
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