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Pain Relief

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Mar 16, 2020.

What is Pain?

If you've ever touched a hot stove, you know pain. Pain is a signal from our body that something is not right. Pain receptors in our bodies send electrical messages to the spinal cord and brain, which we interpret as pain. In certain situations, you are able to retract from pain to stop the hurt. In most cases, however, the pain is either short-lived (acute) or ongoing (chronic).

Medically, pain can be a signal for another condition. It can be due to a physical injury, a malignant disease, or an emotional upset. Most types of physical pain can be treated with pain relievers, but it's important to use these safely. What kinds of pain medications are there?

  • Analgesics such as acetaminophen or paracetamol are used to treat mild or moderate pain, and can also be used to reduce temperature in fevers.
  • Narcotic analgesics such as codeine can be used alone or in combination with other analgesics for stronger pain, such as dental pain, menstrual pain or migraines. Short-term use of these medication is important.
  • Non-steroidal anti-inflammatory drugs (including aspirin) are used to reduce pain associated with inflammation, such as sports injuries, and can also be used to relieve fever.
  • Acetaminophen, the NSAIDs ibuprofen or naproxen, and aspirin are all available over-the-counter (OTC).

Common Pain Conditions

There are many acute and chronic pain conditions, including:

Musculoskeletal Pain

  • back and leg pain
  • neck, shoulder and arm pain
  • "whiplash" injuries
  • motor vehicle, work-related and sport injuries
  • post surgical pain 
  • arthritis
  • fibromyalgia

Cancer Pain

  • primary and metastatic cancer pain (cancer that has spread to distant areas of the body)
  • medication side effect management

Pain Linked to Other Conditions

Neuropathic Pain

  • Complex Regional Pain Syndrome (RSD)
  • shingles
  • neuralgia
  • nerve Injuries
  • phantom limb pain

Over-the-Counter (OTC) Pain Medications

  • acetaminophen (Tylenol)
  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve)
  • aspirin (Bayer)

Over-the-counter medications, which you can buy without a prescription, are good for many types of pain.

Acetaminophen

Acetaminophen (Tylenol) is good for relieving minor pain, headache and fever. It is less irritating to the stomach than other over-the-counter pain medications, such as NSAIDs. It can, however, be toxic to the liver if you take more than the recommended dose. Be sure to look at the total amount of acetaminophen in all of the medications you take and do not exceed 4 grams (4,000 mg) of acetaminophen per day in adults. Also avoid excess alcohol consumption if you take acetaminophen to lower further risk of liver toxicity.

NSAIDs

Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) are examples of non-steroidal anti-inflammatory drugs (NSAIDs). These reduce inflammation caused by injury, arthritis, or fever. NSAIDs also relieve pain associated with menstruation, dental pain, and headache. Take these medications in regular dosing intervals as directed by the manufacturer on the package. If you have high blood pressure, kidney disease, or a history of gastrointestinal ulcers or bleeding, you should consult your health care provider before using any over-the-counter NSAID.

NSAIDs can increase your risk of heart attack or stroke that can be fatal, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking NSAIDs. Do not use an NSAID just before or after heart bypass surgery (coronary artery bypass graft, or CABG). Talk to your doctor about the use of over-the-counter NSAIDs.

Can You Give Aspirin to Children?

DO NOT give aspirin to children. Reye's syndrome is associated with the use of aspirin to treat children with viral infections, such as chicken pox or the flu. This syndrome can cause brain and liver damage. Reye syndrome is most often seen in children ages 4 to 12.

Prescription Pain Relievers

Prescription medications may be needed for more severe types of pain. There are specific uses and risks of prescription narcotic and non-narcotic medications. Because these drugs can be linked with side effects like drowsiness, constipation, slowed breathing and addiction, it is best to try non-narcotic pain relievers for mild, temporary, pain. For nerve (neuropathic) pain, anticonvulsant medications such as gabapentin may be used.

There are alternate methods to help reduce pain that may be helpful instead of, or in addition to, pain medications. These include:

  • heat for sore or overworked muscles
  • ice applied to recent injuries (such as a sprained ankle)
  • massage
  • resting the affected body part
  • biofeedback or relaxation techniques.

Consult your doctor if pain lasts longer than a few days, if over-the-counter pain medications are not helping to reduce the pain, or if other symptoms arise. A consultation with a pain clinic or other specialist may be helpful for control of long-term pain.

Table 1. Common U.S. Pain Relievers

Generic Name Common US Brand Names Drug Class
acetaminophen Children's Tylenol, Tylenol  Pain reliever
acetaminophen and codeine Tylenol with Codeine Opioid/acetaminophen combo
acetaminophen and hydrocodone Lortab, Norco, Vicodin Opioid/acetaminophen combo
acetaminophen and oxycodone Endocet, Percocet, Roxicet Opioid/acetaminophen combo
celecoxib Celebrex NSAID (COX-2 inhibitor)
duloxetine Cymbalta, Drizalma Sprinkle, Irenka Antidepressant (SNRI)
fentanyl Actiq, Duragesic, Fentora Opioid
gabapentin Gralise, Horizant, Neurontin Anticonvulsant
hydrocodone Hysingla ER, Zohydro ER Opioid
ibuprofen Advil, Motrin IB, Midol, PediaCare NSAID
naproxen Aleve, Anaprox DS, Naprosyn NSAID
oxycodone OxyContin, Roxicodone Opioid
pregabalin Lyrica Anticonvulsant
tramadol ConZip, Ultram, Ultram ER, Ryzolt Opioid
venlafaxine  Effexor XR Antidepressant (SNRI)

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See Also

Sources

  1. U.S. Centers for Disease Control and Prevention (CDC). CDC Guideline for Prescribing Opioids for Chronic Pain. Accessed March 14, 2020 at https://www.cdc.gov/drugoverdose/prescribing/guideline.html
  2. American Academy of Pain Medicine. AAPM Facts and Figures on Pain. Accessed March 14, 2020 at https://painmed.org/clinician-resources/patient-education-resources
  3. FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. 7/9/2015. Accessed March 14, 2020 at https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory
  4. Common Painkillers Tied to Slight Rise in Heart Attack Risk. Drugs.com. May 9, 2017.
  5. Aleve. Bayer. Frequently Asked Questions. Accessed March 15, 2020 at https://www.aleve.com/faq/dosage/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.