Pain Medicines: Pros and Cons of the 5 Main Options

Possible benefits and risks of common medications used to treat chronic pain
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Acetaminophen (Tylenol)

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

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.

Opiates

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.

Neurologic medications

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.


over 1 year ago, said...

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over 3 years ago, said...

"Vicodin contains a high dose -- 500 milligrams, to be exact -- of acetaminophen in combination with codeine". Your statement is not correct. Vicodin contains acetaminophen & Hydrocodone. Hydrocodone is stronger than codeine but only one-tenth as potent as morphine at binding to receptors and reported to be only 59% as potent as morphine in analgesic properties.


over 3 years ago, said...

Knowing the risks involved with taking nortriptyline antidepressant.


over 3 years ago, said...

Although I am older and have taken aspirin or Advil or Tylenol off and on throughout my life, I didn't really have a good understanding of the differences. I just thought they were basically all the same. Good to know and possible side effects also.


over 3 years ago, said...

I enjoyed this article, the break down of the different types of meds is very helpfull. I know I have arthritis in my back although my doctor has never discussed it with me, I get alot of my self diagnosis from web sites such as this one and treat myself. My pain is chronic and I suffer at work everyday


almost 4 years ago, said...

Rather an important field. useful explanatory detail! Ibuprofen is used a bit too frequently, I feel, but it has its anti-inflammatory (curing rather than just relieving, I think) strength so I do use. Chronic osteoarthritis in both knees is my one major problem. Tending to limit activity, so the effort HAS to be made to keep as mobile as possible. The pain killing ability does help, but the under-strength knee can wobble when in mid-stride: needing a bit of care when trying to progress. That's it from my side, so the need to assist remains. Tablet can only be taken with food to assist absorption & restrict stomach wall damage. Thank you & happy & Holy Christmas to one & all!


almost 4 years ago, said...

Pain explanation and stages of medications. There is a great deal of embarrassment in our society at not being able to withstand pain. Watching animal programs on t.v. I was so thrilled to see them mention pain meds for animals, actually surprised, but this seems to be a part of the whole understanding that it is not evil to want relief.


almost 4 years ago, said...

All "pill" assists are advisedly used with caution. Their input often overrides, which can cure/help one side but cause other problems: avoid if at all possible is perhaps the best, long term advice


about 4 years ago, said...

Yes good info. I have fibromyalgia, and the laundry list of ailments that can often occur after having this for many years ,chronic fatigue ,bi=lateral carpal, to name a few. Im on pain meds and an anticonvulsant, and I taken antianxiety meds to help me sleep. One bad night sleep and the next day Im suffering with pain all over. Im allergic(or sensitive to ) antidepressants and Im afraid to try them anymore for fear of adverse reactions. Its a catch 22 because I know they would help me with sleep. I have heard Dr. Drew say that fibro is a sleeping disease and anyone with it need to get off pain meds and it disturbs the brain and disrups sleep. Need to exercise and eat a healthy diet. problem is when you exercise it hurts and the vicous cycle starts. more pain, more pain meds.UGH! I appreciate the facts though, so thanks.p.s.The only time I don't feel pain is when I had an hour long massage ,with my very knowagable therapist, trained with Polarity, and physical therapy. Those are the best days I have.


about 4 years ago, said...

reinforced basic info about pain killers


over 4 years ago, said...

Which drugs work well with Remicade; how to use them with Remicade and Methotrexate. Aides for Long Time Chonic Pain.


over 4 years ago, said...

*boxer (ex-golden gloves boxer, not boxes, lol)


over 4 years ago, said...

Sorry...I forgot to say my comment was basically directed at Mz-worry and Bittersweet Baby - those of us who don't get much, if anything, for pain - and seriously need/deserve something. I have arthritis (back and knees), fibromyalgia, migraines, herniated disks from C-1 to the T-3 areas, 'possible' MS (Multiple Sclerosis) - but the doctors can't seem to figure out if I do or don't after 11 years and all the usual tests, arthma and allergies, high blood pressure (lack of pain meds probably makes it higher due to constant pain) - my father died of his FINAL stroke at age 55 and I never thought I'd make it to his age, hypothyroidism, PTSD, anxiety, panic disorder, nerve pain - likely from being by an ex-golden gloves boxes for a few years (having my nose broken twice, amongst other things), depression (wonder why?), IBS, GERD, and I've probably left out a thing or two. But it's 'all in my head' according to some of these MDs who think the acronym stands for 'Medical Deity.'


over 4 years ago, said...

I'm with you on this. I've never even been drunk, much less addicted to alcohol or drugs...and I don't care to be, having seen too many people turn into a**holes doing it. I've been disabled since I was 37 years old and things have gotten worse, not better. Can't take any kind of NSAIDS because my GI doc took me off them 10+ years ago. Doctors would at least prescribe things like Vicoden and Xanax to me when I was younger...now I get nothing other than gabapentin and muscle relaxants, and I'm 56 years old. If I could afford it, I'd move to a different state, since it seems Arkansas is the only one that won't prescribe pain meds people like us who deserve it and have medical necessity (although we had a neighbor whose only 'problem' was that she was an alcoholic on Medicaid who was prescribed 4 different Class I narcotics...go figure that one out (and I dropped a dime on her and her doctors if the government ever bothered to follow it up). Even when my back 'went out' again recently - it happens every so often - and I couldn't get to an E.R. (was also having chills and running a fever in excess of 103 degrees) and having loss of bladder control, I couldn't even get my neurologist's office to call me back or to call in anything, even temporarily, for pain. If this is all there is left, I don't WANT to 'exist' from now on, because that's all I'm doing any more! If I'm 'lucky,' I get to go downstairs every 6 weeks to get my hair cut in our senior building; other than that, I never leave our apartment because I can hardly walk. :-(


over 4 years ago, said...

A bombshell yesterday...You have RA, It's kind of better then Lupus or MS I do hydroconone at night to sleep a few hours soundly without waking up every 10 minutes. I was just pescribed Methotrexate, 6 tablets once a week and Prednisone, 1 tablet every morning with food or milk. Pain and swelling have decreased within 24 hours, At least the feeling of an ice pick jammed into my joints has subsided some. Scary part is the side effects, liver damage and so on. I'll just be aware and watch for signs. I have a saying I coined about myself, I went from Special forces to I don't qualify for Special Olympics. I'll keep you posted on the newest battle in my life, Heres Looking at you kid.


over 4 years ago, said...

Good information and very true! I worked for a pain MD for several years and learned the same infomation. It sometimes takes conbination of several of these drugs to get relief. Also, I always ask for combination meds including Tylenol to give me the smallest dose of Tylenol or delete it completely. Is safer to be on long term meds that way.


over 4 years ago, said...

hopefully this topics can always be saved. is there any way to save it?


over 4 years ago, said...

what can topamax do to you after years of use


over 4 years ago, said...

I noticed some people are concerned with how to treat chronic knee pain. I had four operations on my right knee before finally getting a total knee replacement at 58. Think long and hard about doing that because my knee pain is just as bad as before the knee replacement. In fact, now I have addional pain that shoots from my knee to the groin area. So, basically it's worse than it was. Just one more piece of advice. The arthroscopic surgery should greatly improve things by the 2nd try. A total of four surgeries from three hacks never improved my pain or returned my knee strength.


over 4 years ago, said...

Anonymous....I agree that a dr doesn't force meds down ur throat.BUT I wasn't aware of the effects of the meds.The same dr,yr after yr,kept prescribing them.I went to him&asked him to send me for a second opinion.They told him they were agreed with the meds,but to take the tylenol component out.So,he did.Every year for the yrs following,I would ask again.He would send me.A dr in 2007 said I needed to be seen by a pain specialist,bc in his opinion,I needed to be weaned off&try other treatments.So,he sent me to the specialist(the others were Orthopedics).The specialists wanted me to try injections,which I WAS afraid of.My dr chose to keep me on them.I went to him,crying,&told him I thought I was addicted.He then proceeded to tell me that I was dependent¬ addcited.I do not personally feel there is a difference.I knew I needed pain meds,but I was not in control of my life,what life was left,that is.So,one month,actually the day of my appointment,to get refills,I decided I had had it.I went to a Methadone clinic,for short term daily treatment,for about 7 months,&then was admitted into a rehab 4 hrs from my home for a month.I have a psych dr now,who works with me,due to issues,stemming from that accident&all that happened.I have taken my 12 yr old(THEN)child,to the dr,for a sprained ankle&he was given VICODIN.Thats INSANE!!I do believe that people should account for them selves,but where is the drs responsibility??I was with the same dr,about 6yrs.I asked him to send me to others,for opinions/alternatives.He was a family physician.I do not think he should have been able to keep me on that much,that long.Yes,I should have went&gotten help,sooner.But by then,I was lost.I just think drs should have to advise patients of alternatives/other meds/therapies and advise them of addiction&them sign something.I did NOT know anything about meds when this happened.I was medflighted&on them a month,in the hospital,before going home to be taken care of by family,for 6months in a medical bed,in my livingroom.It was ROUGH.It is rough now.BUT I can see.I am all'fogged'up--if that makes sense.Which to others who have had an issue usually does.Lastly,I am not offending nor diagnosing anyone.I just want others to know,do the research.Have someone do it for you if you can't.Be aware.Be scared,bc it is a scary thing.Prescriptions are at an all time high being written,being abused,being sold&being bought.I am fortunate...to be in pain,but have my life.I know there will come a time,when I may need it again...I pray never...but I am going to do every possible thing I can,before it ever comes to that bc when u were on as much as I was(mind u same dr,6yrs),you are bound to need help eventually.To end this,I want u to know how bad it got...6yrs...&MY DR was prescribing me 80mg Oxycotin,#60 a month along with Percocet 15mg(uncut),#280 a month.&yes,that is what it reads!Then bc of the narcotics,stress,panic attacks,along with issues from the car accident...HE sent me to a psych dr who put me on Xanax.Like I needed any more help:(.I am just happy to be alive.As far as OLDLADY>>I am sooo sorry,but I have never heard of it,Just mmake sure u have all the info available.I understand pain can be great.There are days I can't get out of bed.So,we each have to be seen on a personal basis&dealt with as such.I am just saying..know what is going on.