Pain Medicines: Pros and Cons of the 5 Main Options
Possible benefits and risks of common medications used to treat chronic pain
Works for mild to moderate pain but doesn't reduce inflammation. This means acetaminophen is less effective on muscular aches and pains and doesn't do much to ease the swelling and fluid buildup around arthritic joints. Be aware of how much you're taking alone and in combination, since acetaminophen is an ingredient in many combination medications such as multi-symptom cold remedies and prescription painkillers. Many people don't realize, for example, that the prescription drug Vicodin contains a high dose -- 500 milligrams, to be exact -- of acetaminophen in combination with codeine.
Risks: Taking too much acetaminophen can cause serious liver problems, so monitor your intake carefully and talk to your doctor if you're pushing the limits of safety. Recent studies have warned of the dangers of a "staggered overdose" caused when chronic pain sufferers repeatedly take higher-than-recommended doses of acetaminophen over long periods of time, incurring liver damage that goes undetected until it becomes severe enough to land them in the hospital. Acetaminophen should also be used with extreme caution by heavy drinkers, since their livers are already under siege.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen (Advil, Motrin) and naprosyn (Aleve) are available over the counter; other NSAIDs such as diclofenac (Voltaren) and sulindac (Clinoril) require a prescription. Even over-the-counter NSAIDs are much more effective against inflammation than acetaminophen is. Many NSAIDs also last longer than acetaminophen (six or more hours rather than four) and can help relax you, making it easier to fall sleep.
Risks: All NSAIDs can cause potentially serious side effects, especially in older adults. These include digestive upset, irritation of the stomach, ulcers, and bleeding of the digestive tract, as well as decreased kidney function and worsened high blood pressure. These side effects are common even when one sticks to recommended daily limits. For these reasons, NSAIDs should not be used regularly in people with a history of kidney problems, and the American Geriatrics Society recommends these painkillers be used only rarely among the elderly. Some recent studies have also shown that long-term use of NSAIDs for chronic pain raises the risk of cardiovascular problems, including heart attack and stroke, so discuss your heart disease risk with your doctor if you're using NSAIDs frequently.
Aspirin is often a good starting point for mild to moderate pain, but it's most effective against inflammation at fairly high doses, which can cause complications. That's why doctors often switch to prescription NSAIDs when, for example, arthritis worsens.
Risks: Aspirin can cause ulcers and stomach bleeding. Also, aspirin thins the blood, so it may cause or worsen bleeding and should be used with caution in those taking blood-thinning medications.
Opiate drugs are the next step for many struggling with chronic pain. These include drugs that combine acetaminophen with an opiate such as codeine, hydrocodone, and oxycodone (Tylenol #3, Vicodin, Percocet), as well as uncombined opiate medications such as morphine, oxycodone, hydromorphone, and fentanyl. Some formulations are short-acting, whereas others, like OxyContin, are sustained-release. While many people fear addiction from opiates, it's important to understand that addiction is much less likely when a medication has been prescribed for pain than if the same medication is taken simply to get "high."
Risks: Opiates can be extremely dangerous in combination with alcohol, so be sure to stop drinking, or discuss with your doctor if you drink more than one drink per day. Because dependence and addiction can occur with long-term use, opiate pain medications are best considered as short-term solutions to get through flare-ups. If you're relying on opiates month after month, talk to your doctor about whether physical therapy, surgery, or other treatment options might be a better solution. Don't discontinue use suddenly on your own, though; follow the doctor's orders to decrease the dosage gradually.
When pain has continued for some time, it can affect the nervous system in such a way that the pain becomes residual and chronic. Doctors have found that some antidepressants and anticonvulsants (drugs used to control seizures) can, at low doses, be effective in controlling this type of pain. Among the antidepressants most commonly used for pain are the tricyclics amitriptyline (Elavil), duloxetine (Cymbalta), nortriptyline (Aventyl, Pamelor), imipramine (Tofranil), and desipramine (Norpramin). Among the anticonvulsants used are gabapentin (Neurontin), topiramate (Topamax), carbamazepine (Tegretol), and pregabalin (Lyrica).
Risks: Many of these drugs are anticholinergics, a type of medication that can easily cause drowsiness, confusion, and poor balance, especially in older adults. All these drugs can cause side effects; read the fact sheet that accompanies the medication you're taking and be on the watch for such symptoms. In addition, some people can have an allergic reaction to these drugs, so make sure your doctor alerts you to any such risk. If you have a history of mood disorders, are currently on an antidepressant, or have taken antidepressants or mood stabilizers in the past, make sure your doctor is aware of it, especially if you had a bad experience with any drug.