Medications for Chronic Pain: Benefits & Risks
Medications can be useful for chronic pain, but there is rarely a pill that eliminates the problem. The challenge is finding enough pain relief to improve daily life while minimizing side effects.
That balance becomes especially important as we get older. Kidney and liver function may decline with age, medications may remain in the body longer, and many older adults take several drugs that can interact with one another. Some pain medicines can also cause dizziness, sleepiness, confusion, or drops in blood pressure, increasing the risk of falls. Others can contribute to stomach bleeding, kidney problems, or cardiovascular complications.
Acetaminophen
Acetaminophen (Tylenol) is widely used because it does not cause the stomach bleeding associated with anti-inflammatory drugs.
However, its pain-relieving effect can be modest, depending on the condition. Taking too much can cause serious liver damage, and acetaminophen is also included in some combination cold and prescription pain medicines.
Anti-Inflammatory Drugs
NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) can be effective for arthritis and some other types of pain.
But regular use can increase the risk of stomach bleeding, kidney problems, fluid retention, and cardiovascular complications. These risks are particularly important for older adults and people with certain medical conditions.
Topical NSAIDs, such as diclofenac gel (Voltaren), can sometimes relieve pain in joints such as the knee or hand while exposing the rest of the body to less medication.
Drugs Originally Developed for Other Conditions
Several medications developed for other conditions can also affect the way the nervous system processes pain.
Duloxetine (Cymbalta), originally developed as an antidepressant, is used for several chronic pain conditions. Older antidepressants such as amitriptyline and nortriptyline are sometimes used for nerve pain, although their side effects can be a particular concern in older adults.
Gabapentin (Neurontin) and pregabalin (Lyrica), originally developed to treat seizures, can help certain types of nerve pain.
These drugs can be quite helpful for some people, but they are not general-purpose painkillers. Dizziness, drowsiness, confusion, and other side effects can be particularly important for older adults because they may increase the risk of falls.
What About Opioids?
Opioids can be very effective for severe acute pain and have an important role in cancer and end-of-life care.
Their role in long-term non-cancer pain is more complicated. Over time, some people develop tolerance, dependence, or significant side effects. Opioids can also cause constipation, sedation, confusion, and falls, and excessive doses can suppress breathing.
For chronic non-cancer pain, they are generally considered only when other approaches have not provided adequate relief and when the expected benefits outweigh the risks.
Finding the Right Balance
The question is not simply, “Which drug is strongest?” A better question may be:
Does this medication improve my ability to walk, sleep, exercise, socialize, or do the things that matter to me enough to justify its risks and side effects?
For many people, medication works best as one part of a broader approach that also includes movement, exercise, physical therapy, better sleep, and other strategies for managing chronic pain.
See Exercise & Physical Therapy for Chronic Pain for more about non-drug approaches to managing persistent pain.
Learn More
CDC — Nonopioid Therapies for Pain Management
An overview of medications and non-drug approaches that can be used instead of or alongside opioids for chronic pain.
National Institute on Aging — Safe Use of Medicines for Older Adults
Practical information about why medication use can become more complicated with age, including side effects and interactions among multiple medications.
CDC — Opioid Prescribing Guideline
Evidence-based guidance on the benefits and risks of opioids and other treatments for pain.