Medicines for chronic pain

Commonly used pain relief medications are not very effective in treating chronic pain and when used long term, can have more side effects. However, there are some medications that can be used alongside physiotherapy, exercise, diet, relaxation and different ways of thinking and responding to pain.

Chronic pain, also called ongoing pain or long-term pain, is pain that lasts longer than 3 months. It is often described as pain that does not go away as expected after an injury or illness. Read more about chronic pain.

Are pain relief medications helpful?

Treating chronic pain is complex. Treatment usually won’t make the pain go away. Instead, the aim of treatment is to find ways to reduce the impact pain has on your life.

Commonly used pain relief medications are a useful option for treating short-term (acute) pain, but they are not very effective in treating chronic pain and when used long term, can have more side effects. However, there are some medications that can be used alongside physiotherapy, exercise, balanced diet, relaxation and different ways of thinking and responding to pain. Read more about reducing chronic pain – what you can do to help yourself.

Which medicines can be used and when?

Medication Usefulness
Paracetamol Paracetamol is used to treat mild-to-moderate pain. For some types of chronic or long-term pain, taking paracetamol at regular set times is likely to be most helpful.
  • It can be used on its own or with other pain relief medication.
  • When taken at the correct dose, it is generally safe with few side effects.
Read more about paracetamol.
Antidepressants
such as amitriptyline, nortriptyline 		 These medicines are usually used to treat depression but low doses can be used to treat nerve pain caused by shingles, diabetes, stroke and spinal cord injury.
  • Some antidepressants have also been found to improve sleep and aid in relaxation.
  • For antidepressants to work you must take them every day, even when you don't have pain. If you only take them when you need pain relief they will not work.
Read more about amitriptyline and nortriptyline. 
Gabapentinoids such as gabapentin, pregabalin  Gabapentinoids can be used to treat nerve pain caused by shingles, diabetes, stroke and spinal cord injury. They help to dampen down the activity in the nerves that are irritated or damaged.
  • For gabapentin or pregabalin to work you must take them every day, even when you don't have pain. Taking them only when you need it for pain relief will not work.
  • Some people find gabapentin works best, others prefer pregabalin, but you shouldn’t take them both together.
Read more about gabapentin and pregabalin.
Non-steroidal anti-inflammatories (NSAIDs)

Examples include ibuprofen, diclofenac, naproxen and celecoxib. NSAIDs can be used for a short time when you have a flare-up of symptoms.

  • These medicines treat inflammation and this is not often the cause of chronic pain.
  • If used long term they can have harmful side effects.
  • If long-term NSAIDs are thought to be your best option, you will need to have regular checkups with your doctor and blood tests.
Read more about NSAIDs.
Opioids

Examples include codeine, tramadol, morphine and oxycodone. Opioids can be used to treat moderate-to-severe pain that comes on suddenly (acute pain) or for chronic pain caused by cancer.

They are not recommended for other types of chronic pain because they:

  • don’t work well to improve pain levels or help you to be able to do the things you want to do
  • are associated with unpleasant side effects in about 20–30% of people, such as constipation, nausea, dizziness and sleepiness
  • can lead to dependency and addiction if used long term.
Read more about opioids.

Have a pain management plan

If you are using medicines for chronic pain, it is a good idea to develop a pain management plan with your doctor, which can be discussed and then written down. This plan should provide you with clear guidance on how to use your medicines correctly, including:

  • the dose and how often to take them
  • when or if you can increase the dose
  • common side effects
  • how to reduce the dose and stop medicines as your pain improves.

It should also include a review schedule, such as seeing the doctor again within 2 to 4 weeks of starting a medicine or changing a dose, to see if you have any side effects and assess how well your pain is controlled.

Learn more

Medicines for chronic pain Pharmac, NZ

References

  1. The principles of managing acute pain in primary care BPAC,NZ, 2018
  2. Prescribing gabapentin and pregabalin: upcoming subsidy changes BPAC, NZ, 2018
  3. Managing patients with neuropathic pain BPAC, NZ, 2016
  4. Helping patients cope with chronic non-malignant pain: it's not about opioids BPAC, NZ, 2014
Credits: Sandra Ponen, pharmacist.