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Chronic Pain Medicines
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Am Fam Physician. 2004 Mar 1;69(5):1197-1198.
What medicines can treat chronic pain?
Many medicines can help pain, including the ones listed in this handout. Each one may have side effects. Some side effects can be serious. It is important to listen to your family doctor carefully when he or she tells you how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your doctor or your pharmacist.
Acetaminophen (one brand name: Tylenol) helps many kinds of chronic pain. Remember, many over-the-counter and prescription pain medicines have acetaminophen in them. If you are not careful, you could take more acetaminophen than is good for you. Taking too much acetaminophen can cause liver damage. If you often have to take more than two acetaminophen pills a day, tell your doctor.
Nonsteroidal Anti-inflammatory Medicines
Other medicines that help with pain are called nonsteroidal anti-inflammatory medicines. Examples include ibuprofen (two brand names: Motrin, Advil) and naproxen (two brand names: Aleve [over-the-counter], and Naprosyn [prescription]). You can take these medicines just when you need them, or you can take them every day. When you take these medicines regularly, they build up in your blood to fight the pain of inflammation (swelling) and give general pain relief. Many of these medicines are available in low-dose forms without a prescription. You need to tell your doctor if you are taking any of these medicines regularly.
If your doctor wants you to take one of these medicines, always take it with food or a glass of milk, because the most common side effects are related to the stomach. If you already are taking other pain medicines, do not take these medicines without talking to your doctor first.
Opioids, also called narcotics, can be addictive, so your family doctor will be careful about prescribing them. For many people with severe chronic pain, these medicines are an important part of their therapy. If your doctor prescribes opioids for your pain, be sure to follow the directions carefully. Tell your doctor if you are uncomfortable with the side effects that may go along with these medicines, such as not being able to concentrate or think clearly. Do not drive when taking these medicines.
When you are taking opioids, it is important to remember that there is a difference between “physical dependence” and “psychologic addiction.” Physical dependence on a medicine means that your body gets used to that medicine and needs it to work properly. When you do not have to take the pain medicine any longer, your doctor can help you slowly and safely take less medicine until your body no longer “needs” it.
Psychologic addiction is the desire to use a medicine whether or not it is needed to relieve pain. Using an opioid medicine this way can be dangerous and may not help your pain. If you have a psychologic addiction to an opioid, your doctor may give you another medicine to help with this problem. Or your doctor might recommend that you talk to a counselor. Your doctor might change the medicine that you are addicted to by lowering the dose, changing to another medicine, or stopping the medicine altogether.
Opioid medicines often cause constipation (difficulty having bowel movements). If you are taking a narcotic medicine, it is important to drink six to eight glasses of water every day. Try to eat two to four servings of fresh fruits and three to five servings of vegetables every day. Be sure to tell your doctor if constipation becomes a problem for you. Your doctor may suggest that you take a medicine to treat it.
Some medicines that are used to treat other illnesses also seem to help with pain. For example, carbamazepine (one brand name: Tegretol) is a medication for seizures that may treat some kinds of pain. Amitriptyline (one brand name: Elavil) is an antidepressant that may help with chronic pain in many people. Your doctor may want you to try one of these medicines to help control your pain. Remember, it can take several weeks before these medicines begin to work well.
If you are taking any pain medicine, be sure to ask your doctor or pharmacist before you take any other medicine, either prescription or over-the-counter.
Are medicines the only way to treat chronic pain?
No. Almost anything we do to relax or get our minds off our problems can help control pain. It is important to add relaxing activities and exercise to your daily life, even if you are already taking medicine for pain. You might have to use stress reduction methods for several weeks before you notice a decrease in pain. Your doctor can give you tips about stress reduction and relaxation methods.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 2004 by the American Academy of Family Physicians.
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