Hailey Tran
Pain relievers, also known as analgesics, are used to reduce and relieve pain and inflammation. Pain medicines are typically divided into two groups: anti-inflammatory medications and opioids. Anti-inflammatory drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), include aspirin, ibuprofen, and naproxen, and are often used to treat mild to moderate pain. Opioids, on the other hand, are more potent pain relievers used for moderate to severe pain. They include prescription medications such as oxycodone, hydrocodone, morphine, and codeine. Opioids can be highly effective, but they also carry a higher risk of side effects and addiction. Hospitals typically prescribe opioids for acute pain in emergency departments and post-surgical care, while NSAIDs are more commonly used for chronic pain management.
| Characteristics | Values |
|---|---|
| Pain relievers | Nonsteroidal anti-inflammatory drugs (NSAIDs), Opioids/Narcotics, Acetaminophen, Anticonvulsants, Antidepressants, Muscle relaxants, Corticosteroids |
| NSAIDs | Aspirin, Naproxen (Aleve), Ibuprofen (Advil, Motrin), Meloxicam |
| Opioids/Narcotics | Oxycodone, Hydrocodone, Morphine, Fentanyl, Hydromorphone, Codeine, Tramadol |
| Treatment factors | Cause and type of pain, Race, Age, Sex, Ability to express pain, Underlying illness, Physician awareness, Fear of complications |
| Non-drug treatments | Cortisone shots, Nerve blocks, Applying cold or heat, Exercise, Physical and occupational therapy, Mind-body techniques, Yoga, Biofeedback, Music therapy, Therapeutic massages |
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What You'll Learn
Nonsteroidal anti-inflammatory drugs (NSAIDs)
There are many different types of NSAIDs, including over-the-counter and prescription-strength options. Common over-the-counter NSAIDs include aspirin, ibuprofen, and naproxen sodium. Healthcare providers can also prescribe stronger NSAIDs when appropriate. NSAIDs are typically available as oral tablets, but topical NSAIDs (creams, gels, or ointments) are also available and may provide sufficient relief from muscle and joint pain and inflammation.
It is important to use NSAIDs cautiously and for the shortest time possible at the lowest effective dose. NSAIDs can cause serious side effects, including gastrointestinal issues such as indigestion, nausea, and stomach pain. They may also increase the risk of heart attack and stroke, even in healthy individuals. In addition, NSAIDs may interact with other medications and cause unwanted effects. Therefore, it is essential to consult a doctor or pharmacist before taking NSAIDs to ensure they are safe for you.
If you need to take NSAIDs for an extended period, your doctor may prescribe other drugs to help manage their side effects. Paracetamol, for example, is recommended for mild to moderate pain and fever before NSAIDs due to its fewer adverse effects. It is important to be aware of the potential risks and side effects associated with NSAIDs and to seek medical advice if any adverse symptoms occur.
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Opioids
When prescribing opioids, clinicians must weigh the benefits against the risks, especially for patients with risk factors. When treating patients with risk factors, it is recommended to use a reduced starting dose and consider closer monitoring for adverse effects. The CDC has published guidelines for prescribing opioids for pain, which include recommendations in four key areas: determining whether to initiate opioids, selecting opioids and determining dosages, deciding on the duration of the initial prescription and conducting follow-up, and assessing and addressing potential harms.
To improve the safety of opioid use, the Society of Hospital Medicine (SHM) has developed a consensus statement for clinicians treating adults hospitalized with acute, non-cancer pain. This statement provides clinical recommendations on the safe use of opioids for this specific patient population.
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Over-the-counter (OTC) medicines
There are two types of OTC pain medicines that are commonly recommended for mild to moderate pain: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetaminophen is often considered safer than other pain relievers and is used in many OTC and prescription medicines. However, it is common for people to accidentally take too much, so it is important to be careful not to exceed the recommended daily dosage or use multiple medicines containing acetaminophen. NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). These pain relievers are often most effective for pain and inflammation, such as arthritis or menstrual cramps. They can also help reduce fevers. However, taking more than the recommended amount of NSAIDs may cause nausea, stomach pain, or ulcers.
Ibuprofen is available over the counter in lower doses, typically 100 or 200 mg, while prescriptions are for higher-strength dosages of 400, 600, or 800 mg. Some NSAIDs, such as diclofenac and naproxen, are available over the counter in low doses but require a prescription for higher strengths. Other NSAIDs, like meloxicam, and COX-2 inhibitors, such as celecoxib, are only available with a prescription. These medications may not be suitable for people with certain conditions or taking specific medications.
In addition to OTC medicines, there are also non-invasive techniques to manage pain that do not involve medication. These include applying cold or heat to painful areas, exercise, physical and occupational therapy, mind-body techniques, yoga, biofeedback, music therapy, and therapeutic massages.
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Non-drug treatments
One example of a non-drug treatment is acupuncture, which involves stimulating specific points on the body with thin needles inserted through the skin, pressure, electrical stimulation, or heat. Acupuncture is based on the belief that qi (vital energy) flows through the body along paths called meridians, and triggering these points can rebalance the qi. Research suggests that acupuncture can help manage certain pain conditions.
Another non-drug approach is electrical stimulation, which involves sending a gentle electric current to nerves or muscles to change or block pain signals. Massage therapy is also used to relieve stress and pain by kneading, rubbing, tapping, and stroking the soft tissues of the body. Physical therapy, which includes techniques such as heat, cold, exercise, massage, and manipulation, can help control pain, condition muscles, and restore strength.
Psychotherapy, or talk therapy, uses methods such as discussion, listening, and counseling to treat mental and behavioral disorders associated with pain. Hypnosis is another psychological treatment where a psychologist or doctor guides the patient into an altered state of consciousness. Mind-body interventions like meditation can also help patients focus their attention and minimize distracting or stressful thoughts and feelings.
Behavioral treatments such as cognitive-behavioral therapy (CBT) can help patients address the effects of pain in their lives and view pain as a manageable problem. CBT can lead to long-term improvements, particularly in patients with lower back pain and fibromyalgia.
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Anticonvulsants
Several anticonvulsants have been studied in clinical trials for their effectiveness in treating neuropathic pain. Carbamazepine, the first anticonvulsant studied, is believed to alleviate pain by decreasing conductance in Na+ channels and inhibiting ectopic discharges. Clinical trials have shown positive results in treating trigeminal neuralgia, painful diabetic neuropathy, and postherpetic neuralgia with carbamazepine. Gabapentin, another anticonvulsant, has demonstrated the most robust analgesic effect for neuropathic pain, specifically for painful diabetic neuropathy and postherpetic neuralgia. It is recommended as the first-choice therapy for neuropathic pain due to its positive results and favourable adverse effect profile.
Other anticonvulsants that have shown potential in treating neuropathic pain include lamotrigine, phenobarbital, clonazepam, valproic acid, topiramate, pregabalin, and tiagabine. While these drugs have shown promise in animal models of neuropathic pain, their efficacy in human clinical trials is yet to be fully determined. The role of anticonvulsants in treating neuropathic pain is still evolving, and further research and well-designed clinical trials are needed to establish their effectiveness.
In the UK, carbamazepine and phenytoin are licensed for treating trigeminal neuralgia, while gabapentin and pregabalin are more broadly licensed for neuropathic pain. Anticonvulsants have also been recommended in combination with antidepressants for the treatment of postherpetic neuralgia. However, there is limited evidence supporting the effectiveness of combination pharmacotherapy. The use of anticonvulsants in chronic pain management has primarily focused on neuropathic pain rather than nociceptive pain.
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Frequently asked questions
Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. They are commonly recommended for patients after surgery, following an injury, or for both acute and chronic pain.
Pain relievers can be categorised into two groups: anti-inflammatory or opioids. Anti-inflammatory medications, also known as nonsteroidal anti-inflammatory drugs (NSAIDs), reduce inflammation at the site of pain. Opioids, on the other hand, change the brain's perception of pain.
Some examples of anti-inflammatory pain relievers include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). These are often available over the counter and can be effective for mild to moderate pain.
Opioids are powerful pain relievers that are sometimes called narcotics. They are typically prescribed for moderate to severe pain that is not relieved by other types of painkillers. Examples of opioids include oxycodone, hydrocodone, morphine, and codeine.
Yes, there are several non-drug treatments for pain. These include applying cold or heat to painful areas, exercise, physical therapy, mind-body techniques, yoga, biofeedback, music therapy, and therapeutic massages.
