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The Layperson’s Guide to Painkillers

Cover Story

THE LAYPERSON’S GUIDE TO PAINKILLERS

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.

Illustration of acetaminophen capsule.

ACETAMINOPHEN

WHAT IT IS: 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.

Illustration of oral steroid pill.

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.

Illustration of anticonvulsant pill.

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.

Illustration of depressant pills.

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.

Illustration of topical patch.

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.

Illustration of Non-steroidal anti-inflammatory pills.

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.

Illustration of antidepressant pill.

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.

Illustration of muscle relaxant pill.

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.

Illustration of opioid pill.

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.

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