Medicines can often help control
chronic pain. In some
cases, it may take several weeks for the medicine to work.
Medicine may work best when it's used along with other types of treatment, such as physical therapy and
counseling, to address the different causes of chronic pain.
Sometimes a medicine loses some or all of its ability to work
when it is used daily over a long period of time. This is because your body develops a
tolerance to it.
Pills for pain
You will likely start with medicines that cause the fewest
side effects (such as
acetaminophen). The dose will be
increased or the medicines will be changed as needed.
- Acetaminophen, such as Tylenol.
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin,
ibuprofen (Advil, for example), and naproxen (Aleve, for example).
- Tricyclic antidepressants, such as amitriptyline.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
- Corticosteroids, such as prednisone.
- Oral medicines that act like a local anesthetic.
- Anticonvulsants, such as gabapentin (Neurontin) and
- Opiate pain relievers, such as hydrocodone (for example, Vicodin). These may be used when other medicines do not help.
Medicines you put on your skin
A variety of creams, gels, sprays, and patches may be used to relieve chronic pain, including:
- Topical analgesics. These are pain relievers that are applied directly to
the skin, such as EMLA cream or a lidocaine patch
(Lidoderm). Some creams or gels can be made at the pharmacy according to your doctor's directions. Some may contain capsaicin, a naturally occurring
substance found in chili peppers.
- Cooling spray. This involves using a cooling
spray (such as Biofreeze) directly on the skin. This may be repeated several
Injected medicines—shots—may be used to treat chronic pain, including:
- Nerve block injections. An anesthetic
is injected into the affected nerve to relieve pain. The anesthetic may relieve
pain for several days, but the pain often returns. Although nerve blocks do not
normally cure chronic pain, they may allow you to begin physical therapy and
range of motion.
- Epidural steroid
injections (injecting steroids around the spine). Although these injections
have been used for many years and may provide relief for
low back or neck pain caused by disc disease or
pinched nerves, they may not work for everyone.
- Trigger point
injections. These may relieve pain by injecting a local anesthetic into trigger
points (or specific tender areas) linked to chronic fascial pain or
fibromyalgia. These injections do not relieve chronic pain
Anne C. Poinier, MD - Internal Medicine
Nancy Greenwald, MD - Physical Medicine and Rehabilitation
November 19, 2012
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