Finding relief for chronic pain can be anything but simple. Not only is there the stress of dealing with constant pain, but there’s also the frustration of trying treatment after treatment without results. Over time, this pain can interfere with your work and relationships, sometimes even leading to anxiety or depression.
Fortunately, there’s hope with medication for chronic pain. However, not all medications work the same way. Let’s take a look at the types of medications for chronic pain, how they work, and considerations to keep in mind.
What is Chronic Pain?
Chronic pain is pain that lasts longer than six months. It can be constant or come and go, and it can be mild or severe. However, unlike acute pain, chronic pain doesn’t go away once the original injury or condition heals. Some common conditions that cause chronic pain include:
- Diabetes
- Cancer
- Fibromyalgia
- Circulation problems
About 1 in 4 Americans live with chronic pain, and nearly 1 in 10 say their pain is serious enough to regularly interfere with their work or life. If left untreated, chronic pain can contribute to conditions like depression and anxiety.
How is Chronic Pain Treated?
A doctor will complete a thorough evaluation of your symptoms and pain levels before coming up with a custom pain management plan. Based on the outcome of your exam, your provider may recommend one or a combination of the following:
- Over-the-counter or prescription medication
- Heat or cold therapy
- Steroid injections
- Physical or occupational therapy
- Light or low-impact exercise
- Psychotherapy or group therapy
Types of Medications for Chronic Pain
Several types of medications can be used to treat chronic pain, and finding what works for you may take some trial and error. Some medications are used for short-term relief, while others are used long-term for chronic conditions like fibromyalgia. Below are some of the most common categories of chronic pain medications.
Over-the-Counter Medications
The first line of defense against chronic pain is an over-the-counter (OTC) medication, which can be effective for mild to moderate pain. The following are examples of common OTC pain relievers:
- Acetaminophen (Tylenol)
- Aspirin
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil and Motrin) and naproxen (Aleve)
NSAIDs are the most effective for chronic pain because they reduce inflammation in joints and muscles. For example, oral and topical NSAIDs are strongly recommended as first-line treatments for osteoarthritis as they improve pain and function.
However, NSAIDs are not risk-free. Patients with comorbid conditions, like heart disease, face increased risks for adverse side effects and should speak to their doctor before taking OTC pain relievers.
Antidepressants
Antidepressants are also used to treat chronic pain, especially when the pain is from nerve damage or co-occurs with depression or anxiety. These medications are believed to increase neurotransmitters in the spinal cord that help block pain signals. Here are the different types of depression medications that may be prescribed:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) work well for chronic back pain, fibromyalgia, neuropathic pain, and depression with comorbid pain.
- Selective serotonin reuptake inhibitors (SSRIs) may help treat depression with comorbid pain; however, they show little effect on pain itself.
- Tricyclic antidepressants (TCAs) are used for tension headaches, irritable bowel syndrome, and nerve pain.
Anticonvulsants
Originally developed to treat epilepsy, anticonvulsants are now being used to treat chronic nerve pain that’s felt in conditions like postherpetic neuralgia, diabetic neuropathy, and spinal cord injury-related pain. These medications include gabapentin and pregabalin, and they help relax overactive nerve signals.
While helpful, anticonvulsants aren’t without side effects. These may include:
- Dizziness or blurred vision
- Drowsiness
- Increased appetite or weight gain
- Mood or psychiatric changes in some individuals
Opioids
For moderate to severe chronic pain, your doctor might prescribe an opioid medication. Opioids bind to opioid receptors in the brain and spinal cord. This blocks pain signals and releases dopamine, which can create a sense of relief or sometimes, euphoria. Common prescribed opioids include:
- Hydrocodone
- Oxycodone
- Morphine
- Codeine
When they’re used short-term and under medical supervision, opioids can be safe and effective. However, they carry a serious risk of tolerance, dependence, and addiction, which is why they are prescribed sparingly and when other treatments haven’t worked.
Topical Medications
Topical medications target the pain directly in the spot it’s located. These are another pain relief option for people who can’t tolerate oral medications or want to avoid systemic side effects. They’re applied directly to the skin and come in gels, creams, lotions, patches, sprays, or roll-ons. Common topical treatments include:
- Topical NSAIDs: Used for joint pain
- Capsaicin cream: Helpful for conditions like neuropathy, osteoarthritis, or chronic neck pain
Lidocaine patches or creams: Used for nerve pain, including postherpetic neuralgia, pain after surgery, or localized pain.
How Long Does it Take for Pain Medications to Work?
The timeline for pain relief depends on the type of medication and how it works in the body. Some medications work quickly, while others take time to show any real effect. Here are estimates on how long certain pain relief medications take to work:
- OTC medications and opioids start working quickly, usually within 30 minutes to an hour
- Topical treatments may take a few days of consistent use
- Antidepressants and anticonvulsants may require several weeks before reaching its full effectiveness
Is Chronic Pain Curable?
There’s no cure for chronic pain, but it is highly treatable through a combination of medications, therapies, and lifestyle changes. However, new therapies are being explored to further minimize the impact of chronic pain. One example is Pain Reprocessing Therapy (PRT), and it’s a treatment that’s designed to help the brain unlearn pain signals that are stuck in a chronic loop.
In a recent study, 66% of participants who received PRT reported being pain-free or almost pain-free after just four weeks, compared to only 20% of those who received placebo injections and 10% who received standard care. Improvements in pain were largely maintained a year later. These results show the need for not only treating pain symptoms but also addressing how the brain and nervous system process pain over time.
Other Ways to Manage Chronic Pain
Medication is only one way for managing your chronic pain. It’s possible to find even more relief by incorporating lifestyle changes and mental health support into your routine. Consider the following:
- Low-impact exercise (walking, swimming, or stretching) to reduce stiffness and build strength
- Yoga or pilates to improve flexibility and joint support
- Acupuncture to target pain directly
- Massage therapy to relax muscles
- A healthy diet and consistent sleep schedule for overall health and well-being
- Progressive muscle relaxation or guided breathing to reduce stress and physical tension
In some cases, even talk therapy can benefit chronic pain patients. Therapy can help you process the emotions that come with your pain, tackle the mental stress that your pain triggers, and teach you coping skills.
In fact, studies show that people who receive cognitive behavioral therapy, or CBT, for chronic pain experience less pain and emotional distress compared to those who receive no treatment. These effects are felt immediately after therapy and up to a year later.
Talk to a Provider About Chronic Pain Relief
It doesn’t matter if your pain started months ago or it’s been a part of your life for years. You deserve compassionate, holistic care that makes living with chronic pain possible.
At Cura Behavioral Health, our comprehensive pain management services address the physical and emotional sides of chronic pain. From patient education and psychological support to medication management, we’re here to provide you with the level of care you deserve. Reach out today to schedule your consultation.
Sources:
- A quarter of Americans suffer from chronic pain – Axios
- Pharmaceutical treatment of osteoarthritis – Osteoarthritis and Cartilage
- How Strong Is the Evidence Supporting Antidepressants for Chronic Pain? – NEJM Journal Watch
- The Pharmacological Treatment of Chronic Pain: From Guidelines to Daily Clinical Practice – Pharmaceutics
- Prescription Opioids DrugFacts – National Institute on Drug Abuse
- Topical Nonprescription Pain Medications for Adults – JAMA
- Retraining the brain to treat chronic pain – National Institutes of Health
- Psychological therapies for the management of chronic pain (excluding headache) in adults – Cochrane Library
