Managing Your Pain With Painkillers? Here’s How to Manage the Side Effects

Dealing with chronic pain can come with surprising drug reactions

Jessica Migala,

AARP

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Published June 06, 2024

Illustration of a big pill in the center surrounded by different types of smaller pills, all in the red, white and pink color scheme

Manuel Bortoletti

Medications can be a key element in treating chronic pain, but each type delivers side effects. “We use all the medications with some caution,” says Johns Hopkins Medicine oncologist and palliative care physician Thomas Smith, M.D. Here’s what to know about your options.

Acetaminophen

What they are: Tylenol, Anacin AF, Tactina and store brands

How it’s used: “We often start with acetaminophen, as it works in a specific part of the brain to decrease discomfort,” Smith says. Acetaminophen can be added to other medications for more relief and to help you use less of each drug.

Warnings: Acetaminophen is metabolized in the liver; stick to recommended dosages, as overuse can cause liver failure.

Oral steroids

What they are: Prednisone, hydrocortisone or dexamethasone

How they’re used: To decrease inflammation and pain, for chronic conditions such as rheumatoid arthritis, Crohn’s disease and chronic obstructive pulmonary disease (COPD).

Warnings: Can have side effects, such as swelling, high blood pressure, mood changes and upset stomach, so they’re typically used only in the short term.

Anticonvulsants

What they are: Gabapentin, pregabalin

How they’re used: May be prescribed to treat certain types of nerve pain. Changes nerve endings to reduce pain, but patients often have to try two or three drugs, or a combination, before finding relief.

Warnings: Clumsiness and unsteadiness. Associated with overdose when combined with opioids, as they cause breathing issues.

Depressants

What they are: Prescription benzodiazepines

How they’re used: May be prescribed as part of a cocktail of pain relief, as they can decrease muscle spasms, anxiety and insomnia. However, these are generally not effective to treat chronic pain.

Warnings: Benzodiazepines are dangerous. A central nervous system depressant, they can suppress breathing and can be deadly when combined with an opioid.

Opioids

What they are: Legal prescription opioids include hydrocodone, oxymorphone, morphine, codeine and fentanyl

How they’re used: Extended-release-capsules/tablets may be used to provide a baseline of pain relief, alongside a short-acting opioid as needed, Smith says.

Warnings: Highly addictive, contributing to misuse and overdose, and they’re difficult to come off. Constipation is common.

Muscle relaxants

What they are: Prescription antispastics and antispasmodics

How they’re used: For short-term muscle pain. “Muscle relaxants were never studied to be used long-term, but many patients are prescribed these and take them day in and day out for years,” says UC San Diego pain specialist Timothy Furnish, M.D.

Warnings: Can increase the risk of falls and confusion, mood swings and thoughts of suicide.

Antidepressants

What they are: Tricyclic antidepressants (amitriptyline) and SNRIs (such as duloxetine)

How they’re used: Can be effective for certain types of pain, such as nerve pain and migraine; sometimes used in combination with an anticonvulsant.

Warnings: May cause drowsiness and insomnia or worsen heart problems. Research shows these can increase the risk of falls in older adults.

NSAIDs

What they are: Ibuprofen, aspirin, naproxen

How they’re used: Available over the counter or in stronger prescription formulas, nonsteroidal anti-inflammatory drugs reduce inflammation at the site of the pain.

Warnings: Risks include gastrointestinal bleeding and kidney damage. Taking NSAIDS for more than 15 days in a row can trigger rebound headaches in which the painkiller itself is the cause of the pain.

Topical

What it is: Lidocaine, capsaicin, menthol patches and creams

How it’s used: Topicals work by targeting nerve receptors under the skin, helping to relieve pain. Capsaicin (the compound that gives chile peppers a kick) is effective in treating diabetic neuropathy, especially for those who have trouble tolerating oral medications. Lidocaine and menthol (the cooling sensation found in mint) help to relieve muscle and chronic back pain.

Warnings: Skin reactions, such as burning, redness and itching, as well as nausea.