Acetaminophen acts in the central nervous system to increase the pain threshold. It can help with many kinds of chronic pain. It is important to remember that many prescription and over-the-counter pain medicines have acetaminophen in them. As a result, caution must be exercised because too much acetaminophen could cause serious liver damage, especially if you drink alcohol.
Anticonvulsant drugs help relieve pain by working on nerves. While they are often used to control seizures in patients with epilepsy, they may also block the flow of pain signals from the central nervous system. Common side effects include dizziness, drowsiness, and fatigue. Other side effects may include headache, confusion, rash, nausea, vomiting, swelling or weight changes.
A few examples of commonly prescribed anticonvulsants include:
- Gabapentin (Neurontin®)
- Pregabalin (Lyrica®)
- Topiramate (Topamax®)
- Oxcarbamezepine (Trileptal®)
Antidepressants alter pain transmission and are often used in chronic pain conditions, even when depression isn’t recognized as a factor.
Studies have shown that antidepressants may work by increasing particular chemicals in the spinal cord that reduce pain signals. It may take a few weeks to see the pain relief benefits.
Antidepressants have a wide range of potential side effects. Commonly mentioned ones include, nausea, increased appetite and weight gain, loss of sexual desire, fatigue, dry mouth, vision changes, agitation and anxiety.
A few examples of commonly prescribed antidepressants include:
- Amitriptyline (Elavil®)
- Nortriptyline (Pamelor®)
- Duloxetine (Cymbalta®)
- Venlaflaxine (Effexor®)
Creams, patches and sprays work through different mechanisms and can be placed or rubbed on the skin or joints for management of pain.
A few examples of commonly prescribed creams and patches include:
- Lidocaine patches (Lidoderm®)
- Diclofenac (Voltaren®)
- Capsicum (Capzasin®)
Corticosteroids are among the most commonly used medications in pain medicine.
Corticosteroids act by decreasing substances in the body that cause inflammation and pain. When performing procedures, our specialists often deposit these medications directly at the site of inflammation in order to help alleviate pain. Corticosteroids can cause weight gain, elevated sugars, muscle weakness, stomach upset, anxiety and osteoporosis.
A few examples of commonly utilized corticosteroids include:
- Dexamethasone (Decadron®)
- Triamcinolone (Kenalog®)
- Methylprednisolone (SoluMedrol®)
Muscle relaxants reduce pain from tense muscle groups.
They often work through a variety of mechanisms in the brain. These drugs are used to relieve spasms due to spastic conditions and can be used to relieve musculoskeletal pain.
While each medication has a specific profile, common side effects reported include drowsiness/dizziness, possible addiction or dependence, dry mouth and urinary retention.
A few examples of commonly prescribed muscle relaxants include:
- Tizanidine (Zanaflex®)
- Cyclobenzaprine (Flexeril®)
- Baclofen (Lioresal®)
- Methocarbamol (Robaxin®)
NSAIDs decrease substances in the body that are known to cause inflammation (swelling) and pain. NSAIDs come in both over-the-counter and prescription forms.
These medicines can be taken as needed, or every day depending on how they are prescribed. It is best to take them with food, as the most common side effects are related to the stomach.
NSAIDs may also cause increased bruising or risk of bleeding in the stomach. There are other potential side effects, such as kidney damage or blood clots. Do not take NSAIDs without talking to your doctor first. If you are prescribed NSAIDs, do not combine them with other over-the-counter NSAIDs.
A few examples of commonly prescribed NSAIDs include:
- Ibuprofen (Advil®, Motrin®)
- Naproxen (Aleve®)
- Mobic (Meloxicam®)
- Diclofenac (Voltaren®)
- Celebrex (Celecoxib®)
Opioids work by modifying pain messages in the brain. There are versions for short-term relief, and longer acting versions for sustained relief. For many people who have severe chronic pain, these drugs are an important part of their therapy.
As opioids have several important considerations, review the opioid informed consent and the opioid contract.