Pain Management Health Center

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. If this happens, you may need to take more of the medicine, change medicines, or add another medicine. Your doctor can work with you to do this.

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. Be safe with medicines. Read and follow all instructions on the label.

• AcetaminophenAcetaminophen, such as Tylenol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs)Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, for example), and naproxen (Aleve, for example).
• Tricyclic antidepressantsTricyclic antidepressants, such as amitriptyline.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
• CorticosteroidsCorticosteroids, such as prednisone.
• AnticonvulsantsAnticonvulsants, such as gabapentin (Neurontin) and pregabalin (Lyrica).
• Opiate pain relieversOpiate 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 times.

Injections

Injected medicines-shots-may be used to treat chronic pain, including:

• 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.
• Joint block injections. A corticosteroid is injected into the painful joint or joints.
• Nerve blockNerve 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 improve your range of motion.
• Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) linked to chronic myofascial pain or fibromyalgia. These injections do not relieve chronic pain in everyone.