Which painkiller should you use?

There are many medication options for pain relief. These drugs may be referred to as painkillers or analgesics. Which one is best depends on many factors, including the type of pain being treated and whether you have other medical problems.

Some can be purchased over the counter (OTC) at a store (without a prescription), while others require a prescription (Rx) from your doctor and may even have many regulations.

Some general facts on pain:

• Pain can occur for many different reasons and can exhibit different qualities.
• Pain exists across a spectrum of mild to severe intensity.
• It can last for a short time and resolve on its own, like a simple headache or menstrual cramps. Pain can also come and go or be long-lasting, sometimes referred to as chronic.
• Pain may be a result of an injury, such as a broken bone, or a symptom of another disease or disorder, such as appendicitis, arthritis, migraine headaches or sickle cell anemia.
• Pain can feel differently to different people. Some common descriptions include stabbing, throbbing, cramping, stinging or aching.

It is important to be evaluated for the cause of your pain, especially if it is severe (even for a short time), if it is long-lasting (even if it is not severe) or if it keeps recurring.

The Centers for Disease Control and Prevention recommends that you work with your doctor to make a plan for your pain, set goals for pain outcomes and activity, and choose the lowest risk pain relief option. Your provider will want to know:

• What the pain feels like
• When it happens
• How long it lasts
• What helps to relieve it

Understanding the cause and type of pain you have will help you to choose the best options for treating it. Sometimes non-drug therapy—such as massage, physical therapy or biofeedback—can be helpful on their own or in combination with drug therapy. Also, if the pain is caused by a disease or disorder, treating the underlying condition may relieve the pain.

Which pain reliever and what drug formulation is the best choice at any given time depends on the type of pain being treated, whether it is acute or chronic, the treatment setting (hospital vs. community), and any other diseases you have and medications you take because there can be unwanted interactions.

Pain relievers from different drug classes in combination may sometimes be recommended for better relief.

Common pain reliever options

Acetaminophen

• Rx Status: Mostly OTC
• Available Forms: LiquidPills (multiple strengths, short- and long-acting options), Suppositories, Injection (Rx only)
• Types of Pain (examples): Headache/migraine, Minor injuries or discomforts, Chronic low back pain, Arthritis
• Comments:
  • No anti-inflammatory properties.
  • Can cause liver damage if overused.
  • Do not take more than 4 grams (from all sources) in 24 hours.
  • When used in combination with opiates, it can decrease opiate requirements.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• Drugs: Aspirin, Ibuprofen, Naproxen, Meloxicam, Diclofenac, Flurbiprofen, Ketorolac
• Rx Status: OTC and Rx
• Available Forms: Liquid, Pills (multiple strengths), Topical creams/gels, Injection
• Types of Pain (examples): Headache/migraine, Pain with a component of inflammation, Menstrual cramps, Chronic low back pain, Arthritis, Minor to severe injury/trauma/surgery
• Comments: When used in combination with opiates, they can decrease opiate requirements.

Opioids and Opiates

• Drugs: Codeine, Tramadol, Hydrocodone, Oxycodone, Morphine, Hydromorphone, Fentanyl
• Rx Status: Rx with limits and restrictions
• Available Forms:Liquid, Pills (multiple strengths, short- and long-acting options), Patches, Suppositories, Injection
• Types of Pain (examples): Severe injury or trauma, Major surgery, Cancer pain
• Comments:
  • Use the lowest effective dose for the shortest duration possible.
  • Concerns for developing addiction.

Some Antiseizure, Antidepressant and Local Anesthetic medications

• Drugs: Gabapentin, Pregabalin, Carbamazepine, Oxcarbazepine, Amitriptyline, Duloxetine, Lidocaine
• Available Forms: Liquids, Pills, Topical creams, Patches
• Types of Pain (examples): Pain related to nerve damage/disorders, Neuropathy, Phantom limb pain, Fibromyalgia, Chronic low back pain, Cancer pain
• Comments:
  • Neuropathic pain can be difficult to treat.
  • It may take several weeks of antiseizure or antidepressant medications to see results.