Pain treatments: Non-prescription

What are over-the-counter pain medicines?

Over-the-counter (OTC) medicines are those that are available without a prescription. Some examples of OTC pain relievers are acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs). Acetaminophen products include Tylenol®. NSAIDs include aspirin, ibuprofen (such as Motrin®), ketoprofen (such as Orudis® KT), and naproxen sodium (such as Aleve®). Some products contain both aspirin and acetaminophen (such as 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. Acetaminophen works on the parts of the brain that receive pain messages. NSAIDs relieve pain by reducing the production of prostaglandins, which are hormone-like substances that cause pain and inflammation.

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 in order 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 like aspirin, but there is no evidence that putting aspirin on the skin is effective. Other topical medicines mask the feelings of pain by making the skin feel warm or cold. 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 opioids?

Opioids are narcotic pain medicines. They are natural, synthetic, or semi-synthetic substances. 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). The risk of addiction is much higher if high doses are used chronically. Opioids are very effective in short term use, but there is conflicting information about how effective they are for long-term use. 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 who are not used to the drugs’ effects.

What are antiepileptic drugs?

A number of antiepileptic drugs have been found to reduce pain caused by damage to nerves, whether caused by diabetes, injury, or other medical conditions. They also reduce pain from fibromyalgia and migraine headaches. Examples of antiepileptic drugs used for pain include gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and oxcarbazepine (Trileptal).

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 (such as Cortaid® or Cortizone®). Other common types of corticosteroids require prescriptions. These include:

  • Prednisone
  • Prednisolone
  • Methylprednisolone
  • Dexamethasone

Prescription corticosteroids are strong medicines and might have serious side effects. Side effects can include:

  • Weight gain
  • Diabetes
  • Gastrointestinal bleeding
  • Headache
  • Mood changes
  • Trouble sleeping

These medicines might also make it harder for the body to fight off infections.

What are antidepressants?

Antidepressants are drugs that can treat pain and/or emotional conditions by adjusting levels of chemicals in the brain called neurotransmitters. These medicines reduce several kinds of chronic pain due to changes they produce in the spinal cord.

Chronic pain conditions treated by low-dose antidepressants include some types of headaches (including migraines), backache, fibromyalgia, and pain from nerve damage. Two types of these antidepressant medicines are serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants. SNRIs include Duloxetine (Cymbalta), venlafaxine (Effexor), and milnacipran (Savella). Tricyclic antidepressants include Amitriptyline (such as Elavil®), desipramine (Norpramin®), doxepin (such as Sinequan®), imipramine (Tofranil®), and nortriptyline (such as Pamelor®).

In most cases, antidepressants are prescribed for a few months. Tricyclics and SNRIs depend on having a steady dose of the medicine buildup 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
  • Fatigue
  • Constipation
  • Trouble urinating
  • Dry mouth
  • Fatigue
  • Nausea
  • Headache

In general, SNRIs have fewer side effects than tricyclic antidepressants.

Other pain treatments

Another means of topical pain relief comes in the form of patches such as a lidocaine patch (Lidoderm®, for example). You need a prescription to get a pain relief patch.

If your pain is not relieved by the usual treatments, your doctor might 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 kinds 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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