Pain treatments come in both non-prescription form and those available only by prescription.
Pain treatments: Non-prescription
What are OTC pain medicines?
Over-the-counter (OTC) medicines are those that are available without a prescription from a doctor. Some examples of OTC pain relievers are acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen products include Tylenol®. NSAIDs include aspirin, ibuprofen (Motrin®), ketoprofen (Orudis®KT), and naproxen sodium (Aleve®. Some products contain both aspirin and acetaminophen (Extra Strength Excedrin ®).
Both acetaminophen and NSAIDs reduce fever and relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation).
Acetaminophen and NSAIDs also work differently. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain and inflammation. Acetaminophen works on the parts of the brain that receive the "pain messages."
What are topical pain relievers?
OTC pain treatments also include topical pain relievers. These products include creams, lotions, or sprays that are applied to the skin to relieve pain from sore muscles and arthritis. Some examples of topical pain relievers include the brands Aspercreme® and Ben-Gay®. Some topical treatments contain a medicine such as aspirin, but there is no evidence that topical aspirin effectively relieves pain.
Other topical medicines "mask" the feelings of pain by making the skin feel warm or cold. An example is capsaicin, which comes from the extracts of chili peppers.
Some topical treatments block the "pain message" from reaching the brain. In general these medicines are safe, even for long-term use.
Pain treatments: Prescription
What are corticosteroids?
Corticosteroids are cortisone-like medicines that are used to provide relief for inflamed areas of the body. These medicines help to ease swelling, redness, itching, and allergic reactions. Often, corticosteroids are used for conditions such as allergies, asthma, and arthritis. Corticosteroids are similar to the natural corticosteroid hormones that are produced by the cortex (outer part) of the adrenal glands. Some corticosteroids are available over the counter, such as lower-strength hydrocortisone creams (Cortaid®, Cortizone®).
Other common types of corticosteroids require prescriptions. These include:
- Prednisone
- Prednisolone
- Methylprednisolone
- Dexamethasone
Prescription corticosteroids are strong medicines that may cause serious side effects. Side effects may include weight gain, diabetes, upset stomach, headache, mood changes, and trouble sleeping. These medicines might also make it harder for the body to fight off infections. Efforts are under way to develop safer corticosteroids.
What are opioids?
Opioids are narcotic pain medicines that contain natural, synthetic or semi-synthetic derivatives of morphine. Opioids are often used for acute pain, such as short-term pain after surgery. Some examples of opioids include:
- Morphine
- Fentanyl
- Oxycodone
- Codeine
Opioids are effective for severe pain and do not cause bleeding in the stomach or other parts of the body. It is rare for people to become addicted to opioids if the drugs are used for acute pain (such as after surgery). However, there is always a risk of dependence. Some side effects of opioids include drowsiness, nausea, constipation, and itching. The drugs can also interfere with breathing when given in large doses to patients that are not accustomed to the drugs’ effects.
The lay and medical communities’ major concern about opioid medications is psychological dependence (addiction). This is a form of behavioral disorder that involves the obsession with obtaining opioids for non-analgesic (euphoric) purposes. About 10% of the population may exhibit addictive tendencies.
What are antidepressants?
Antidepressants are drugs that can treat pain and/or emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. These medicines can increase the availability of the body's signals for well-being and relaxation, enabling pain control for people with chronic pain conditions that do not completely respond to the usual treatments.
Chronic pain conditions treated by low-dose antidepressants include some types of headaches (like migraines) and menstrual pain. Some antidepressant medicines include:
- Selective serotonin reuptake inhibitors (SSRIs)—citalopram (Celexa®), fluoxetine (Prozac®), paroxetine (Paxil®), and sertraline (Zoloft®)
- Tricyclic antidepressants—amitriptyline (Elavil®), desipramine (Norpramin®), doxepin (Sinequan®), imipramine (Tofranil®), and nortriptyline (Pamelor®)
When used for pain, antidepressants usually are prescribed for a few months. These drugs, especially tricyclics and SSRIs, depend on having a steady dose of the medicine build up in the body over a period of time. In general, antidepressants have fewer long-term side effects than frequent, ongoing use of other pain medicines.
The most common side effects of antidepressants include blurry vision, constipation, difficulty urinating, dry mouth, fatigue, nausea, and headache. Generally, SSRIs have fewer side effects than tricyclic antidepressants.
Other pain treatments
Another means of topical pain relief comes in the form of a lidocaine patch (Lidoderm®), which is a prescription medicine.
If your pain is not relieved by the usual treatments, your doctor may refer you to a pain management specialist. Doctors who specialize in pain management might try other treatments such as certain types of physical therapy or other types of medicine. They might also recommend a TENS unit, a device that uses patches placed on the skin to send signals that stop pain.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/12/2007...index#12058
