Opioids are pain medications used for moderate to severe chronic pain. Though their long-term use has been somewhat controversial, most providers feel when carefully monitored, opioids have a place in chronic pain management. Opioids may be short-acting or long-acting pain medications, however in chronic pain management the latter is more commonly used.
Different types of opioids are used for different types of chronic pain. These pain medications are available in both pill or patch form. Intravenous opioids are also available, though they are more commonly used for cancer pain, or as post-surgical acute pain medication. Some examples of opioids used to treat chronic pain are oxycodone and fetanyl. Opioids may be used alone, or they may be combined with other pain medications such acetaminophen.
While opioids are often effective against chronic pain, they do have potential complications. Opioids can cause nausea, drowsiness, constipation, sexual dysfunction and may lead to physical dependence. If you take opioids regularly for chronic pain, your doctor should monitor you closely for signs of pain medication complications.
NSAIDs and acetaminophen are non-opioid analgesics, pain medications often used for mild to moderate chronic pain. NSAIDs and acetaminophen may be used alone to treat chronic pain, or they may be combined with other pain medications such as opioids and adjuvant analgesics. They may also be used to control breakthrough pain.
Unlike opioids, many NSAIDs are available over-the-counter. Acetaminophen is also available for purchase without a prescription. However, stronger prescription versions are also available for chronic pain treatment. Some examples of NSAIDs used for chronic pain are ibuprofen, naproxen and meloxicam.
While NSAIDs and acetaminophen are readily available pain medications, they do have potential side effects. Long-term use increases the chance of these side effects, however even short-term use can leave you vulnerable. These include gastrointestinal ulcers and bleeding as well as increased potential for bruising. Some types of NSAIDS, in particularly the selective COX-2 inhibitors, may increase your risk for heart attack or stroke. However, each medication is different and you should talk to your doctor about the risks and benefits of each.
Antidepressants are adjuvant analgesics. They are not formulated specifically as pain medications, though they can effectively treat certain types of chronic pain. Antidepressants are thought to control chronic pain in two ways. First, they may change the way pain is perceived from the spinal cord to the brain. Second, they may decrease anxiety and help regulate sleep.
Not all types of antidepressants are useful as chronic pain medications. Tricyclic antidepressants (TCAs) such as amitriptyline, selective serotonin reuptake inhibitors (SSRIs) such as duloxetine and some others such as nefazodone are commonly used to treat both chronic pain syndromes and nerve pain. Monoamine oxidase inhibitors (MAOIs), on the other hand, are not as effective in pain control.
Though it might sound strange, anticonvulsants, usually used to control seizure disorders, can also be used as pain medication. Anticonvulsants are also adjuvant analgesics. Because they work by inhibiting certain types of nerve transmissions, they can decrease neuropathic pain sensations, such as those caused by trigeminal neuralgia or diabetic neuropathy. Anticonvulsants commonly used as pain medications include gabapentin and pregabalin.
Topical analgesics are pain medications that are applied to the skin. They are available as creams, lotions or patches. Some types of topical pain medications may be purchased over-the-counter, while others require a doctor’s prescription. The work in a few different ways, depending on their active ingredient. Some topical analgesics contain pain medication that is delivered through the skin, such as trolamine salicylate (Aspercreme). Others contain a skin irritant that can interfere with pain perception, such as capsaicin.
Using Pain Medication Wisely
You may take a certain type of pain medication for your condition, or you may use a variety of those listed above to control your pain. Whatever the case, be sure to use your medication only as directed. Many pain medications have drug interaction warnings, including several of those listed above. If you are taking multiple pain medications, be sure to inform your doctor so he can alert you to any potential complications.
American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. Accessed 6/21/09. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf
The Merck Manuals Online Medical Library. Pain: Treatment. Accessed 6/21/09. http://www.merck.com/mmhe/sec06/ch078/ch078d.html