If you are having any symptoms or have any questions, please call 811 to speak with a registered nurse 24 hours a day.

Chronic pain is a type of pain that continues over time. It can last anywhere from 3 months or more to several years. Chronic pain may be caused by certain health conditions. It is more common in people who are older.

Treatment of chronic pain usually involves medicines and therapy. Medicines used for chronic pain include pain relievers, antidepressants, and anticonvulsants. Different types of medicines help people who have different types of pain. You usually use long-acting medicines for constant pain. Short-acting medicines treat short-term, or acute, pain.

Path to improved health

The goal of chronic pain treatment is to increase function and quality of life.  Different types of medicines help people who have different types of pain.  For instance, short-acting medicines treat pain that comes and goes. Long-acting medicines treat constant pain.

The most common medicines are listed below. Each one may have side effects. These can range from mild to severe. It’s important to follow your healthcare provider’s orders on how to use your pain medicine. If you have questions about side effects or about how much medicine to take, ask your healthcare provider or pharmacist.

Acetaminophen

Acetaminophen helps many kinds of chronic pain. One brand name is Tylenol.  It is also found in many over-the-counter and prescription pain medicines. If you’re not careful, you could take more acetaminophen than is good for you. Taking too much acetaminophen could cause liver damage, especially if you drink alcohol. If you often find that you have to take more than 2 acetaminophen pills a day, contact your healthcare provider.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Other drugs that help with pain are called nonsteroidal anti-inflammatory drugs, or NSAIDs. Examples include aspirin, ibuprofen (two brand names: Motrin, Advil) and naproxen (one brand name: Aleve). NSAIDs come in both over-the-counter and prescription forms. These medicines can be taken just when you need them, or they can be taken every day.  When these medicines are taken regularly, they build up in the blood to levels that fight the pain of inflammation (swelling) and also give general pain relief.

Always take NSAIDs with food or milk because the most common side effects are related to the stomach.  Other side effects include:

• Increased bruising.
• Risk of bleeding in the stomach.
• Kidney damage (when taken for long periods of time).
• High blood pressure.
• Interference with blood pressure medicines.

If you are taking other pain medicines, don’t take NSAIDs without contacting your healthcare provider first.

Antidepressants

Many drugs that treat other illnesses can also treat chronic pain. For example, antidepressants can improve function and provide pain relief. Antidepressants may be used to treat nerve damage, arthritis, and fibromyalgia. They also may help with headaches, facial pain, low back pain, and pelvic pain. It can take several weeks for the medicines to start working.

Types of antidepressants your healthcare provider may prescribe include:

• Tricyclic antidepressants (TCAs), such as amitriptyline (Elavil), imipramine (Tofranil), nortriptyline (Pamelor), and doxepin.
• Selective serotonin/norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Possible side effects of antidepressants include:

• nausea
• drowsiness
• insomnia (trouble sleeping)
• dry mouth
• dizziness
• constipation
• weight gain
• heart problems

TCAs tend to have more side effects than SNRIs or SSRIs, but they usually are mild. Your healthcare provider may start you on a low dose of medicine. This helps prevent side effects and allows your body to adjust. The healthcare provider may increase the amount over time. If at any point while taking medicine you become depressed or have suicidal thoughts, call your healthcare provider right away.

Anticonvulsants

Your healthcare provider may want you to try an anticonvulsant medicine. It may help reduce some types of chronic pain, such as low back pain. Examples of anticonvulsants are:

• gabapentin (Neurontin)
• carbamazepine (Tegretol)
• phenytoin (Dilantin)
• pregabalin (Lyrica)
• topiramate (Topamax)

Like antidepressants, your healthcare provider may start you on a low dose of anticonvulsants. This helps prevent or reduce side effects. The healthcare provider may increase the amount over time. Contact your healthcare provider right away if you have suicidal thoughts. Minor side effects may include:

• drowsiness
• nausea or vomiting
• restlessness
• dizziness
• loss of appetite
• weight gain
• itching or swelling

Narcotics

Doctors may prescribe narcotics or opioids to treat chronic pain. However, they are highly addictive. People who become addicted can develop severe symptoms, such as increased pain, depression, or suicidal thoughts. They may begin to abuse other substances, or their behaviors could become harmful or violent. People who are addicted are at risk of misusing or overdosing on narcotics, which can cause death. Talk to your healthcare provider about all risks of narcotics before starting a new medicine.

If your healthcare provider does prescribe a narcotic, be sure to follow their directions. Do not drive or operate heavy machinery when taking narcotics. Do not use alcohol as well. Tell your healthcare provider if you have side effects from narcotics. These may include nausea, constipation, and trouble focusing or thinking clearly. Your healthcare provider can prescribe an anti-nausea drug or laxative to help with side effects.

When you’re taking narcotics, it’s important to remember that there is a difference between “physical dependence” and “psychological addiction.” Physical dependence means that your body adjusts to a medicine and needs it in order to function. When your function has improved, your healthcare provider will help you slowly and safely decrease the amount of medicine. Doing this helps prevent or reduce symptoms of withdrawal. It is critical to tell your healthcare provider about these symptoms and work through the process together.

Psychological addiction is the desire to use a drug whether or not it’s needed to improve function or relieve pain. Using a narcotic this way is harmful to your health. . Contact your healthcare provider if you think you are addicted to narcotics. They may give you other medicines to help your addiction. They could lower the dose, change to another drug, or stop the medicine. They may recommend counseling or rehab as well.

Things to consider

Always tell your healthcare provider and pharmacist what other drugs you take. This includes medicines, vitamins, and supplements. The healthcare provider also should know about all ongoing health conditions. Some medicines may not be safe to take. Do not start a new drug without your healthcare provider’s approval.

It is important to follow instructions when taking chronic pain medicines. Some side effects can be harmful and cause other health concerns. They can also be harmful to your lifestyle if you develop a problem. Do not stop taking a drug without your healthcare provider’s approval.

When to see a healthcare provider

People who take medicine for chronic pain should have regular check-ups with their healthcare provider. Contact your healthcare provider right away if you have severe or abnormal side effects. This includes if you have an unplanned reaction. The healthcare provider will tell you what you should do. Seek help if you think you are dependent on or addicted to a drug.

FOR MORE INFORMATION

Chronic Pain Association of Canada
http://chronicpaincanada.com/