Types of Pain Relief Medications

Reviewed on7/9/2021

Types (classes) of pain medications

Painmedications are drugs used to relieve discomfort associated withdisease,在jury, orsurgery。Because the painprocessis complex, there are many types and drug classifications of pain drugs that provide relief by acting through a variety of physiological mechanisms. Thus, effectivemedicationfornervepain will likely have a different mechanism of action thanarthritispain medication.

  • Nonsteroidalanti-在flammatory drugs (NSAIDs) act on substances在the body that can cause在flammation, pain, andfever。
  • Corticosteroids are often administered as an injection at the site of musculoskeletal injuries. They exert powerful anti-inflammatory effects. They can also be taken orally to relieve pain from, for example, arthritis.
  • Acetaminophen在creases the body's pain threshold, but it has little effect on inflammation.
  • Opioids, also known asnarcoticanalgesics, modify pain messages in thebrain。
  • Musclerelaxants reduce pain from tense muscle groups, most likely throughsedativeaction in thecentral nervous system。
  • Anti-anxiety drugswork on pain in three ways: they reduceanxiety, they relax muscles, and they help patients cope with discomfort.
  • Someantidepressants, particularly tricyclics, may reduce pain transmission through thespinal cord。
  • Someanticonvulsantdrugs also relieve the pain of neuropathies, possibly by stabilizing nerve cells.

For what conditions are pain medications used?

Virtually any disease as well as most injuries and surgical procedures involve some degree of pain.

  • It's not surprising, then, that pain medications, also known as analgesics, are among the most commonly used drugs in the U.S. Different medications are used depending on the type of pain.
  • Forminorcomplaints, such as muscle sprains or headaches, anover-the-counter(OTC) pain reliever will usually do.
  • Prescriptionpain relievers, especiallyopiate止痛剂——通常为moderate-t保留o-severe pain – such as that seen after surgery,trauma, or from certain diseases likecancerorrheumatoid arthritis。
  • Other common "painful" situations in which analgesics find use includelabor,back pain,fibromyalgia, andurinary tract在fections.

What are the differences among the types of pain medications?

Pain medications can be broadly classified into two categories:

  • prescription and
  • nonprescription.

In the nonprescription category are several mild anti-inflammatory drugs (ibuprofen,naproxen), as well as acetaminophen. These are mainly meant for use with short-term,acute pain--menstrual cramps,tensionheadaches, minor sprains -- what are known colloquially as "everyday aches and pains." Over-the-counter pain relievers, especially acetaminophen, are also sometimes used to treatchronic pain, such as that seen in arthritis. These drugs also lower fever and are often used for that purpose.

The prescription arsenal against pain is extensive. It also includes some NSAIDs more powerful than their over-the-counter cousins as well asopioidanalgesics. And then there are some unconventional analgesics – drugs that were not originally developed as pain-relievers, but which were found to have pain-relieving properties in certain conditions. For example, fibromyalgia pain medications include an antiseizure drug (pregabalin[Lyrica]) and anantidepressant(duloxetinehydrochloride [Cymbalta]).

Onemajordifference between anti-inflammatories and opioid analgesics is that the former have a "ceiling effect" -- that is, continuous dose escalation does not provide concomitant escalation in pain relief. One reason opioids are so useful in the treatment ofchronicpain is that astoleranceto a dose develops, the dose can be raised. In fact, there is no limit to how high opioid dosing can go -– keeping inmindthat higher doses can be associated with unpleasant and/or even dangerous side effects.

What are the strongest pain medications?

  • Opioid analgesics, in general, are the strongest pain-relieving medications. The benchmark drug in this class ismorphine-- with other opioids falling above or below it in terms of pain-relieving potential. Near the bottom of the list iscodeine, usually prescribed in combination with acetaminophen to relieve, for example, pain resulting from dental work.
  • Codeineis only about 1/10th as powerful as morphine.
  • Opioidsmore powerful than morphine includehydromorphone(Dilaudid) andoxymorphone(Opana).
  • But the strongest opioid in community use is fentanyl which, in its在travenousform, is 70 to 100 times more potent than morphine. Fentanyl is also available as a long-release patch (Duragesic) and as a lozenge that dissolves in themouth(Actiq).
  • Sufentanilis even more powerful than fentanyl, but its use, at present, is restricted to the intravenous route.
  • However, a transdermal patch containing sufentanil is inclinical trials。

What are the side effects of pain medications?

NSAIDs

All NSAIDs come with the risk ofgastrointestinalulcerationand bleeding.

  • A newer class of anti-inflammatories, theCOX-2在hibitors, was developed to reduce this risk. It did not, though, eliminate it.
  • In fact, another major issue emerged with these drugs: the possibility of severe and deadlyvascularproblems with long-term use, includingheart attackandstroke。

Acetaminophen

Most users of acetaminophen experience few, if any, side effects.

  • But the drug can causeliverdamage, especially when taking too much or if taken withalcohol。

Opioids

Opioid analgesics commonly cause drowsiness,dizziness, andrespiratory depression。However, these side effects usually disappear with continued use. However,constipation, another common side effect, tends to persist. In addition, opioid use may lead toaddictionor dependence. Other possible side effects of opioid analgesics include:

Mixed opioid agonist-antagonists

Patients can experience symptoms of opioid withdrawal if a straight opioidanalgesic, such as morphine, is taken at the same time as an opioidagonist-antagonistdrug. Some of these medications include pentazocine (Talwin Nx,Talacen,Talwin Compound), butorphanol, and nalbuphine (Nubain).

Muscle relaxants

肌肉松弛剂的主要副作用是drowsiness. This may be how they work to "relieve" pain. In addition, carisoprodol (Soma) use may lead to dependence because in the body it is converted into a drug similar tobarbiturates;cyclobenzaprine(Flexeril) can causedry mouth, constipation, confusion, and loss ofbalance;methocarbamol(Robaxin) discolors theurine绿色,棕色或黑色;这两个metaxalone(Skelaxin) andchlorzoxazone(Parafon Forte, DSC) should be used with caution in those with liver problems.

Anti-anxiety agents

Anti-anxiety drugs also carry the risk of sedation, particularly if combined with certain other medications (such as opioid analgesics) or alcohol.

  • Other possible side effects include psychological changes,headache, nausea, visual problems, restlessness, and nightmares.
  • Chest painandheart-pounding are also possible.

Antidepressants

Some of the antidepressants used for pain relief are the older tricyclics. These come with numerous side effects classified asanticholinergic, including

Other possible side effects include

A few of the newer antidepressants also reduce pain -- and with less risk of anticholinergic issues. Still, theserotonin-norepinephrinereuptake在hibitors (SNRIs) may cause the following common side effects:

Antiseizure agents

Side effects associated with the anticonvulsants used forpain managementcommonly disappear over time. They include

  • dizziness,
  • drowsiness, and
  • swelling of the lower extremities.

Corticosteroids

In general, short-term and/or low-dosecorticosteroiduse results in few side effects. But taking corticosteroids long-term can result in severe side effects, including:

What are the warnings/precautions with pain medications?

  • Acetaminophencan be toxic to the liver and should be used with caution, if at all, in people withliver disease。The maximum recommended dose of acetaminophen is 4 grams per 24 hours, but moderate-to-heavy alcohol drinkers need to have the dosage adjusted downward.
  • NSAIDsmay cause bleeding in thestomach。To reduce this possibility, they should be taken withfood。These drugs may causekidneyfailure in those with kidney or liver disease. Also, some NSAIDs increase the risk ofcardiovascularevents.
  • Opioid analgesicsmay result in dependency. Operating amotorvehicle or machinery may be dangerous while using these pain medications because they can cause drowsiness. Opioids may slow downbreathing。与酒精混合阿片类药物or certain other centrally-acting drugs could make this effect even worse.
  • Death and serious side effects have occurred with the use offentanyl transdermal patches。Fentanyl patches are not recommended as startingtherapy在在experienced opiate users. The heat from the sun, hot baths, or heating pads can increase thespeedof fentanyl release from patches.
  • 芬太尼颊tabletshave just one在dication: treatment of breakthrough pain in cancer patients who are using and who have grown tolerant to opiates. Inappropriate use of fentanyl buccal tablets has resulted in death.
  • Methadonecanaffectthe heart. Patients slated formethadonetherapy should first have an EKG to check for abnormalities.
  • Mostmuscle relaxantscause drowsiness. Metaxalone and chlorzoxazone should be used with caution in people with liver disease. Dantrolene can be toxic to the liver. Carisoprodol use may result in dependence.
  • Anxiolytics or anti-anxiety medications-- especially the benzodiazepine class -- may cause drowsiness. Sudden withdrawal from these drugs can result in seizures and possibly death.
  • Someantidepressantmedications may cause drowsiness. The older antidepressants (the tricyclics) interact with a wide array of drugs, sometimes with fatal results -- and they can affect the heart.
  • Patients usinganticonvulsantsas well as newer antidepressants should be monitored for signs and symptoms ofsuicidalthoughts.
  • Orally administeredcorticosteroidsforacute在flammation should not, in general, be suddenly withdrawn. Doses are customarily tapered down over time and patients must follow instructions exactly.

Pain medications list

Examples of nonprescription pain medications include:

Examples of prescription medications include the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

COX-2 inhibitor

Opioid analgesics

Mixed opioid agonist/antagonists

  • Pentazocine/naloxone(Talwin NX)
  • Butorphanol
  • Nalbuphine (Nubain)

Antidepressants

Anticonvulsants

Fibromyalgia medication

Anxiolytics

Muscle relaxants

  • Baclofen(Lioresal)
  • Carisoprodol (Soma)
  • Chlorzoxazone (Parafon Forte, DSC)
  • Cyclobenzaprine (Flexeril)
  • Dantrolene (Dantrium)
  • Metaxalone (Skelaxin)
  • Methocarbamol (Robaxin)
  • Orphenadrine (Norflex)
  • Tizanidine(Zanaflex)

Corticosteroids

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Reviewed by:
Joseph Carcione, DO
American board of Psychiatry and Neurology

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