Examples of Some Non-Opioid Pain Treatment Options

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

There are many different drugs in this family of pain relievers. They all relieve mild to moderate pain and reduce fever and inflammation. They decrease the formation of natural substances in the body called prostaglandins. Prostaglandins serve to protect a number of areas in the body such as the stomach and kidneys. They are also produced at sites of injury or inflammation and allow pain receptors in the surrounding area to become more sensitive to pain. By decreasing prostaglandins, NSAIDs lessen the sensation of pain and reduce inflammation.

Aspirin (acetylsalicylic acid) is the oldest NSAID and was introduced into medicine in 1899. A large number of aspirin-like drugs have been developed since that time. Aspirin, ibuprofen, naproxen sodium, and ketoprofen are the only NSAIDs available over-the-counter (OTC) without a prescription.

NSAIDs are effective against mild to moderate pain, and are important for the management of both acute and chronic pain. For example, an NSAID may be the only analgesic needed to control pain after a minor injury or surgical procedure. As pain treatment options, they are often used in combination with other drugs such as opioids for pain after surgery because, when combined in this way, the pain can often be well controlled with a smaller dose of the opioid. This may help to avoid some of the common side effects of opioids.

The most common side effects of NSAIDs involve the gastrointestinal (GI) tract. They can produce anything from heartburn to ulcers to bleeding. Serious problems, like ulcers or bleeding, can occur without warning. While taking these medicines with food or milk may reduce stomach upset, this will not protect you against the development of ulcers or bleeding from the GI tract.

Tramadol

Tramadol is in a class of medications called opiate agonists and is used to relieve moderate to moderately severe pain. It works by changing the way the body senses pain. Tramadol extended-release tablets are only used as pain treatment options by people who are expected to need medication to relieve pain around-the-clock for a long time. Tramadol is available only with a doctor's prescription.

The effects of tramadol are similar to other analgesics and may become habit-forming, causing mental or physical dependence. It is important not to take a larger dose, take it more often, or take it for a longer period of time than prescribed by your doctor. Call your healthcare professional if you find that you want to take extra medication or if you notice any other unusual changes in your behavior or mood. If you decide you want to stop taking Tramadol, talk to your healthcare professional. He/she will probably decrease your dose gradually, preventing you from experiencing possible withdrawal symptoms.

Acetaminophen

Acetaminophen can be used to relieve mild to moderate pain and treat fever, but it is not an NSAID and does not reduce inflammation. It produces few, if any, side effects at the doses that can relieve pain, but it can damage the liver when used in large doses. Acetaminophen overdose is a medical emergency. The labeling specifies an upper limit of 4 grams in 24 hours (which is equivalent to 500mg acetaminophen tablets). Persons with liver disease or a history of alcohol abuse should limit their use to much less than this and should consult their healthcare professionals about the safest and most appropriate dose to use.

There are many combination pain medicines that contain an opioid with acetaminophen. Be careful with these drugs as they contain different amounts of acetaminophen. Be sure to check the amount with your pharmacist. Don't decide to take extra acetaminophen on your own if a combination pain medicine is not controlling your pain because you may end up using too much acetaminophen and that could cause liver damage. Be aware that many OTC cough, cold and sinus remedies and combination pain relievers also contain acetaminophen, meaning you could be taking more of the drug than you realize. You should also be aware there is a risk of kidney damage if you take acetaminophen for months or years, especially if you take it together with an NSAID.

Adjuvant Analgesics

Adjuvant analgesics are drugs that are used to treat other illnesses, but have been found to serve as pain treatment options for certain kinds of pain. These include certain antidepressants, anticonvulsants, corticosteroids and some other drugs used by pain specialists. Adjuvant analgesics are particularly important pain treatment options for neuropathic pain.

Topical Analgesics

There are other drugs that are effective pain treatment options when used topically. One of these topical analgesics is capsaicin, which comes from chili peppers. It must be applied several times a day for about six weeks to get a benefit. It can cause burning where it is applied, so you have to be very careful that you don't get it in your eyes. There are many other ointments that you can buy in the pharmacy; some contain menthol and may be helpful for musculoskeletal pain.

A Multimodal or an Integrative Approach

In some cases, pain is best managed by using a combination of treatments. This is referred to as a "multimodal" or an "integrative" approach. For example, your healthcare professional may prescribe a medication along with activities to reduce stress (e.g., yoga, deep-breathing exercises). To improve daily functioning, specific non-drug therapies may be suggested to increase muscle strength and flexibility, enhance sleep and reduce fatigue, and assist you in performing usual activities and work-related tasks.

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