Various over-the-counter (OTC) and prescription medications are available to treat chronic pain. Doctors will work closely with a person to determine the best pain medication for them.
There are several levels of pain medications, including nonprescription, nonopioid, adjuvants, mild opioids, and strong opioids.
Depending on the cause of the pain, doctors may begin treatment with nonprescription, nonopioid medications. If these do not work, they may move on to prescription or opioid options.
This article covers the kinds of medication a person may take to treat chronic pain.
Doctors
COX is an enzyme the body uses to make prostaglandins. Prostaglandins play a role in the inflammatory response, which is the body’s response to injury. There are
COX inhibitors
Several categories of COX inhibitors are available, including:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- COX-2 selective (c2s) NSAIDs
- aspirin
To begin with, doctors will prescribe the mildest medication they believe will successfully control the pain. This aligns with the World Health Organization’s (WHO) guidance on pain management in its analgesic ladder.
The WHO advises doctors first treat pain with nonopioids, such as acetaminophen or NSAIDs. If pain levels are severe, then doctors may prescribe stronger medications.
Adjuvants
Adjuvant medications are another potential treatment option. These are medications that are not primarily intended to treat pain but may help enhance pain relief or manage the side effects of pain-relieving medications.
Examples include antidepressants and anticonvulsants.
Acetaminophen has the brand names Tylenol, Panadol, and Actamin.
Although it is not clear how acetaminophen eases pain,
If a person has a condition that affects the liver, they should avoid drinking alcohol if they take acetaminophen.
Dose
Acetaminophen comes in varying strengths.
According to DailyMed, a person can typically take two 325 milligram (mg) capsules every 6 hours.
It also states that, unless a doctor instructs otherwise, a person should avoid:
- taking more than 12 tablets in 24 hours
- taking acetaminophen for more than 10 days
- taking more than 3,250 mg in 24 hours
However, the dosing may differ for those with chronic pain. A doctor will provide the appropriate dosage instructions based on a person’s individual needs.
When a person takes acetaminophen for chronic pain, they will require frequent monitoring to test their liver function.
Side effects
Side effects of acetaminophen are rare, providing a person takes the correct dose. However, it is possible to experience a severe allergic reaction.
People should seek emergency medical care if they develop the following symptoms:
- inflamed, peeling, or blistering skin
- a rash
- hives
- itching
- swelling of the face, throat, lips, tongue, eyes, hands, feet, ankles, or lower legs
- hoarseness
- difficulty breathing or swallowing
There are many different types of NSAIDs, such as ibuprofen (Advil or Motrin) and naproxen (Aleve).
Most NSAIDs inhibit both COX-1 and COX-2.
Dose
The dosage will vary depending on the type of NSAID.
For ibuprofen, a person can typically take a 200 mg tablet every 4–6 hours. However, they should avoid taking more than 6 tablets in 24 hours.
A
For naproxen, a person can take one 220 mg tablet every 8–12 hours.
As NSAIDs can increase the risk of stomach bleeding, heart attack, and stroke, a person should:
- avoid taking more than directed
- take the smallest dose possible
- drink a full glass of water each time they take a dose
Side effects
NSAIDs can cause side effects, including:
- constipation
- diarrhea
- headaches
- drowsiness
- dizziness
- stomach ulcers
- allergic reaction
C2s NSAIDs are a type of anti-inflammatory drug that healthcare professionals prescribe to treat chronic pain syndromes.
While most NSAIDs inhibit both COX enzymes, c2s NSAIDs
One example of a c2s NSAID is celecoxib (Celebrex). It comes in the following strengths:
- 50 mg
- 100 mg
- 200 mg
- 400 mg
Dose
Because this kind of medication can increase the risk of cardiovascular and gastrointestinal events, doctors will typically prescribe the lowest dose for the shortest time possible.
DailyMed notes the following dosage instructions for 50 mg tablets of celecoxib:
| Medical condition | Dosage instructions |
|---|---|
| Osteoarthritis | 200 mg per day as a single dose or 100 mg twice daily |
| Rheumatoid arthritis | 100–200 mg twice daily |
| Ankylosing spondylitis | 200 mg as a single dose or 100 mg twice daily |
Dosing may change based on various factors, such as the cause of a person’s chronic pain and their age. People should always follow the instructions a doctor provides.
Side effects
Some side effects of c2s NSAIDs may include:
- gastrointestinal issues, such as diarrhea, nausea, and abdominal pain
- peripheral edema, which is swelling of the feet, ankles, legs, hands, and arms
- back pain
- dizziness
- headache
- insomnia
- rash
Aspirin is another type of NSAID that relieves mild to moderate pain. As with other NSAIDs, aspirin works by inhibiting the production of prostaglandins.
OTC aspirin tends to come in doses of 325 mg or 500 mg.
It also comes in the form of an extended-release tablet in the
- 81 mg
- 325 mg
- 500 mg
- 650 mg
Dose
DailyMed states that a person can take one or two 325 mg tablets every 4 hours or three tablets every 6 hours.
A person should consult a doctor if they wish to take higher doses of aspirin.
Aspirin is unsuitable for children as it can increase their risk of developing Reye’s syndrome, a rare but fatal condition.
Side effects
Aspirin can cause some side effects, including:
- nausea
- vomiting
- stomach pain
- heartburn
If any of the following serious side effects occur, a person should contact a doctor immediately:
- hives or a rash
- swelling of the face, lips, tongue, or throat
- breathing problems
- hoarseness
- a fast heartbeat
- fast breathing
- cold, clammy skin
- ringing in the ears
- loss of hearing
- blood in vomit or stool
- vomit that looks like coffee grounds
- black or tarry stools
If other medications are not working, a doctor may prescribe opioids. They
Opioids attach themselves to special receptors on nerve cells throughout the body. They block pain signals coming from the spinal cord through the nervous system.
Some types of opioids include:
- tramadol
- codeine
- hydromorphone
- tapentadol
- methadone
- oxymorphone
- morphine
- oxycodone
- hydrocodone
- fentanyl
A medication may have an “ER” or “IR” following its name. ER means extended release, and IR means immediate release. A doctor may prescribe opioids alongside acetaminophen or NSAIDs.
While opioids are effective, they can be addictive. A
Dose
Dosage will depend on the medication and the condition a doctor is trying to treat. General guidelines suggest that a doctor prescribe the lowest dose possible, to begin with.
A person should discuss all their current medications, supplements, and alcohol consumption with the doctor before starting opioid treatment.
Side effects
Opioids can produce side effects. These may include:
- sleepiness
- constipation
- nausea
- vomiting
- dizziness
- itching
- nightmares
- confusion
- hallucinations
A person should not stop taking opioids suddenly. When it is time to stop the medication, they should work with their doctor to taper it off so the body can adjust.
These may include the following:
Antidepressants
Doctors do not primarily administer antidepressants for pain relief. However, they may help control chronic pain in low doses.
Their mechanism of action is not well-understood, but antidepressants appear to interrupt pain signals between the brain and spinal cord.
According to the Oxford American Pain Library, doctors may prescribe the following tricyclic antidepressants in doses of 10–150 mg:
- amitriptyline
- doxepin
- trimipramine
- imipramine
- clomipramine
- desipramine
- nortriptyline
It also states that doctors may recommend the use of serotonin-noradrenaline reuptake inhibitors (SNRIs). These may include venlafaxine (Effexor) in doses of 37.5–225 mg or duloxetine (Cymbalta) in doses of 60–120 mg.
Side effects
Tricyclic antidepressant side effects can include:
- dry mouth
- blurry vision
- constipation
- problems passing urine
- drowsiness
- weight gain
- sweating
- heart rhythm issues
SNRI antidepressants can also have side effects. These may include:
- agitation and nervousness
- gastrointestinal issues
- insomnia
- headaches
- sexual dysfunction
- loss of appetite
- dry mouth
- problems urinating
- weight gain
Anticonvulsants
Anticonvulsants, also called antiepileptic drugs, are medications to treat chronic nerve pain and some inflammatory pain. They change the way the brain perceives pain signals.
Examples of anticonvulsants a doctor might prescribe include:
- pregabalin
- gabapentin
- carbamazepine
Dose
Dosage will depend on the condition and the individual.
Typically a doctor will start with the lowest possible dose and slowly increase it if necessary.
Side effects
Anticonvulsants can have side effects, including:
- weakness or tiredness
- headache
- shaking
- vision problems
- anxiety
- unsteadiness
- gastrointestinal issues
- increased appetite
- weight gain
- swelling of the hands, feet, ankles, or lower legs
- fever
- ear pain
- red, itchy eyes
Most health insurance plans have some prescription coverage. People with insurance should check with the administrator of their plan about their available coverage.
Individuals without health insurance may qualify for Medicare, which covers pain management under two separate parts.
Medicare Part B provides for services that may help treat chronic pain, such as physical therapy, occupational therapy, and acupuncture for chronic lower back pain.
Medicare Part D covers opioid pain medications and medication therapy management for complex health needs.
People may also receive help from the following organizations:
Managing chronic pain can be challenging. Depending on the cause of their chronic pain, a person may wish to try the following alongside their prescribed medications:
- Acupuncture: A 2018 meta-analysis notes that acupuncture may be an effective option to help treat chronic pain.
- Yoga: Although yoga does not appear to help with headaches, arthritis, or fibromyalgia, it
may be beneficial in reducing pain related to the neck and lower back. - Mindfulness and meditation: A
2017 systematic review and meta-analysis suggests that mindfulness meditation may help reduce pain symptoms. It may also help improve a person’s quality of life and symptoms of depression. - Psychotherapy: Therapists may be able to work alongside other healthcare professionals to address the emotional and physical aspects of a person’s pain.
The
The Self-Management Resource Center can help people find programs near them.
People may also wish to speak with a healthcare team or therapist to develop a self-help guide for chronic pain and plan for potential flare-ups.
Below are some commonly asked questions about pain medication for chronic pain.
How can a person deal with severe chronic pain?
The National Health Service (NHS) in the UK recommends the following for severe chronic pain management:
- exercising and continuing to work, if possible
- physical therapy
- taking painkillers
Which painkiller is best for long-term use?
Acetaminophen, also
It is typically best for treating mild to moderate pain or combined with an opioid analgesic for severe pain.
What drug is commonly prescribed for chronic pain?
Doctors
Several categories of COX inhibitors are available, including:
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- COX-2 selective (c2s) NSAIDs
- aspirin
What drugs do doctors prescribe for severe pain?
For severe pain, a doctor may prescribe a person with a strong opioid.
Some examples of opioids include:
- tramadol
- codeine
- hydromorphone
- tapentadol
There are many medication choices for managing chronic pain.
A doctor will generally begin with the mildest medication appropriate for the pain level, according to the WHO’s analgesic ladder. From there, options for prescription, adjuvant, and opioid therapies are available.
All medications have potential side effects and may interact with other drugs. People should discuss each medication’s risks and side effects with a doctor.