Medications for Chronic Pain

Ann Rhomberg, R.N.
University of Iowa Hospitals and Clinics
Department of Obstetrics and Gynecology
Peer Review Status: Internally Peer Reviewed
First Published: 1994
Last Revised: March 2003

Not all drugs work well for chronic pain. The "ideal" drug would get rid of pain, not cause side effects, would not cost much, and would not become addictive. This drug does not exist, of course, but let's look at some common drugs and see how close they come to being "ideal."

NSAIDs -- (non-steroidal anti-inflammatory drugs)--a large group of drugs that includes many that you likely have heard of, for example, Ibuprofen, Naprosyn, Toradol, Anaprox, Relafen.

• How well do they work? Responses to the drugs vary from person to person and drug to drug. What works well for one person may not help the next. Having so many NSAIDs to choose from, we have found that we can almost always find one that will work for a certain patient. Research also has shown that NSAIDs work better if taken on a routine basis rather than just when the pain becomes severe.
• Side effects: Most people have no side effects. The most common side effect is nausea. In rare cases ulcers may develop, most often with high doses. Doctors should use these drugs with caution in patients with kidney disease.
• Addiction potential: None
• Cost: Variable; some are low cost and some not.

Tricyclic Antidepressants (TCAs) -- for example, Imipramine, Doxepin, Amitriptyline

• How well do they work? Again, responses to the drugs vary. These drugs work in two ways. First they improve sleep. Research has shown that improved sleep causes an increase in levels of "endorphin," a natural pain killer. The second way they work is by causing an increase of a brain chemical called serotonin. We find low serotonin levels in both depressed and chronic pain patients. Often antidepressants help both mood and pain problems. It does not surprise us that many persons with chronic pain (at least half) also complain of depression.
• Side effects: With the low doses that we use, most patients have few side effects, and these improve with time. Feeling groggy in the morning, dry mouth and constipation occur in some patients.
• Addiction potential: None
• Cost: Most are fairly low cost.

Narcotics--for example, Tylenol #3, Codeine, Darvocet, Percodan

• How well do they work? Narcotics work very well for short-lived pain. But for chronic pain, research has shown that they tend to make pain worse, causing the patient to need larger and larger doses. Taking narcotics impairs the body's ability to make its own painkillers, endorphins. Endorphins increase with sleep and aerobic exercise and decrease with lack of sleep and narcotic use. Also, they can interfere with thinking and job success.
• Side effects: Constipation, dizziness, nausea.
• Addiction potential: Moderate. With routine use such as with chronic pain, it is just a matter of time before one becomes "tolerant" of narcotics, needing higher doses. They also can become habit forming.

Tranquilizers--for example, Ativan, Xanax, Valium

• How well do they work? Not very well, since they are not really designed to reduce pain. Also, over time they tend to cause sleep problems and increase depression.
• Side effects: Sedation, dizziness, weakness.
• Addiction potential: Moderate. As with narcotics, with constant use, patients can become addicted.
• Cost: Moderate

In summary, NSAIDs and antidepressants appear to be the best choices for treatment of chronic pain. Both narcotics and tranquilizer agents cause addiction and can make pain worse over time.

See related Patient Textbooks about Obstetrics and Gynecology.

See related Patient Topics Brain and Nervous System, Gynecology, Obstetrics and Gynecology, Pain or Symptoms and Manifestations.

See related Provider Textbooks about Obstetrics and Gynecology.

See related Provider Topics Brain and Nervous System, Gynecology, Obstetrics and Gynecology, Pain or Symptoms and Manifestations.

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