- Prescribed a Painkiller? If It’s an Opioid, Read This First
- More Women Are in Pain
- Signs of Opioid Dependence and Misuse
- Opioid Alternatives
- Painkillers | What are they and how do they work?
- Pain Relievers: Types, What They Treat, Risks & Complications
- What are the types of pain relievers?
- What are the types of over-the-counter pain relievers?
- What do over-the-counter pain relievers treat?
- What are the types of prescription pain relievers?
- What do prescription pain relievers treat?
- What are the potential risks or complications of prescription pain relievers?
- Are pain relievers safe during pregnancy?
Prescribed a Painkiller? If It’s an Opioid, Read This First
Pain Management Procedures Pain Management
Maybe you’ve been dealing with chronic pain for a long time. Maybe you’re recovering from surgery and you need short-term pain relief. Whatever the case, you may find yourself with a modern dilemma: whether or not to take prescription pain medication.
Most of the commonly prescribed drugs in this category contain opioids, a class of highly effective but highly addictive pain relievers — which includes oxycodone, codeine and morphine. Although opioids have their place in pain control, they can easily be misused, and this misuse is at the heart of the drug epidemic sweeping the nation.
It’s easy to dismiss the problem as something that could never happen to you, but opioid overdose is now the leading cause of accidental death for Americans.
And it’s a problem that’s worse if you’re female: Women are at increased risk of becoming dependent on or addicted to opioids.
Additionally, while the death rate from prescription drug overdoses dramatically increased overall from 1999 to 2010, it rose 400 percent in women compared to 265 percent in men.
Why is this happening? There are multiple reasons why women are quickly becoming the face of the opioid crisis, says Alexis Hammond, M.D., Ph.D., a psychiatrist in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins Medicine.
More Women Are in Pain
“Women are prescribed pain relievers more often than men,” says Hammond, who also sees patients at the Center for Addiction and Pregnancy at Johns Hopkins Bayview Medical Center. “Part of that has to do with women tending to have lower pain tolerance in general and being more ly to experience chronic pain conditions.”
Women suffer from migraine headaches and neck, facial and lower back pain at up to twice the rate men do. In addition, women are more ly to develop conditions that cause chronic pain. For example, women are three times more ly to develop rheumatoid arthritis and four to seven times more ly to develop fibromyalgia than men are.
“Another component of women being on higher doses of painkillers and using them for a longer period of time has to do with our culture,” explains Hammond. “Unfortunately, it has historically been more socially acceptable for women to ask for help, while men may feel they have to just grin and bear it.”
Once women start taking prescription opioids, they may become dependent on them more quickly than men. Additionally, women are more ly to have depression and anxiety than men and may use opioids as a way to self-medicate a mood disorder.
Some studies, says Hammond, are raising concerns about one more way opioids may be hooking people: The research indicates that long-term opioid use may produce changes in the brain that can make you more susceptible to experiencing pain. That, in turn, makes you want more painkillers.
Even worse? Many people with an opioid addiction eventually turn to heroin, an opioid that’s cheaper to buy on the street than illegal prescription drugs. Although you might think of heroin as a street drug and not related to prescription medications, four five new heroin users first became addicted to prescription painkillers.
Heroin is not dangerous simply because it’s a street drug. “Often, heroin is mixed with fentanyl, which is a very strong opioid and has led to a lot of overdose deaths,” says Hammond. “Using street drugs is so dangerous because you don’t know what’s in them.”
But you don’t have to be on heroin to overdose. You can accidentally overdose if you’re taking a mix of prescriptions or if you drink alcohol while taking opioids, explains Hammond. If you’re taking more than one prescription medication, check with your doctor to see if the drugs have any dangerous interactions.
Signs of Opioid Dependence and Misuse
Opioid dependence is a term used to describe the way your body adapts and begins needing opioids to avoid negative effects.
“If you find that you’re taking medication more frequently than prescribed — say every four hours instead of six — or need frequent refills or your pain is not well-managed, you should talk to your doctor,” says Hammond.
Your body could be developing a tolerance to the drug, which makes you need more medication to achieve the same pain relief.
Another sign of opioid dependence is experiencing withdrawal symptoms in the absence of medication, such as:
- Agitation and anxiety
- Muscle aches
- Abdominal cramping and diarrhea
- Nausea and vomiting
Misuse typically refers to behavior associated with drug use. If you find you’re using prescription opioids for the feeling it gives you (the “high”) instead of pain control, that’s a sign of an opioid use disorder, or addiction. If you can’t stop using the drugs despite negative consequences at work, school and home, that’s also a clear sign of a problem.
Taking an opioid to relieve pain isn’t your only option. Ask your doctor about other types of medications that can ease pain such as non-steroidal anti-inflammatory drugs (NSAIDs) naproxen.
Even some antidepressants, such as duloxetine, may work well to control chronic pain, Hammond says.
Besides medications, you can also try physical therapy, massage therapy, heating pads, acupuncture and lifestyle changes such as increasing exercise and losing weight.
“As doctors, we want your pain to be well-controlled, but we also want to make sure we’re not getting to the point of misusing opioids,” says Hammond. “Some people may do well on long-term opioids. But for most people, there are other medications that are better for chronic pain.”
If you think you are misusing opioids or have become dependent on them, talk to your doctor about appropriate next steps. You can also learn more about our addiction treatment services or explore our opioid resources site for further information on opioids, the science of addiction, and how to prevent and treat opioid dependence.
Painkillers | What are they and how do they work?
Painkillers are medicines that are used to treat pain. There are a large number of painkillers available and they all come in various different brand names. They can be taken:
- By mouth as liquids, tablets, or capsules.
- By injection.
- Via the back passage (rectum) as suppositories.
Some painkillers are also available as creams, ointments or patches.
Even though there are a large number of painkillers available, there are only three main types (each works in a different way). They are:
- Non-steroidal anti-inflammatory drugs (NSAIDS). Examples of NSAIDs include ibuprofen, diclofenac and naproxen. Aspirin is also an NSAID. However, it is mainly prescribed (in low doses) to help to keep the blood from clotting — for example, for people who have had a heart attack in the past.
- Weak opioids and strong opioids (sometimes called opiates). Examples of weak opioids include codeine and dihydrocodeine. Although commonly described as 'weak opioids', they are extremely effective analgesics often used to treat severe pain; however, they can lead to significant addiction and adverse effects, so should not be underestimated. Examples of strong opioids include morphine, oxycodone, pethidine and tramadol. Many people who need strong opioids are in hospital.
Different types of painkillers are sometimes combined together into one tablet — for example, paracetamol plus codeine (co-codamol).
In addition to the above, some antidepressants and antiepileptic medicines can be used to treat neuropathic pain. The rest of this leaflet does not discuss these types of medicines. For more information on them see the separate leaflet called Neuropathic Pain.
There are also other alternative methods for pain relief such as, transcutaneous electrical nerve stimulation (TENS) machine. See the separate leaflet called TENS Machines.
NSAIDs work by blocking (inhibiting) the effect of chemicals (enzymes) called cyclo-oxygenase (COX) enzymes. COX enzymes help to make other chemicals called prostaglandins.
Some prostaglandins are involved in the production of pain and inflammation at sites of injury or damage. A reduction in prostaglandin production reduces both pain and inflammation. Not all NSAIDs are exactly the same, and some work in slightly different ways from others.
See the separate leaflet called Anti-inflammatory Painkillers for more details.
Paracetamol — no one really knows for sure exactly how paracetamol works. But it is also thought to work by blocking COX enzymes in the brain and spinal cord (central nervous system). Paracetamol is used to treat pain and to lower a high temperature. However, it does not help with inflammation.
Opioids work by binding to certain receptors (opioid receptors) in your central nervous system, your gut and other parts of your body. This leads to a decrease in the way you feel pain and your reaction to pain, and it increases your tolerance for pain. See the separate leaflet called Strong Painkillers (Opioids) for more details.
The type of painkiller your doctor will prescribe depends upon:
- The type of pain you have.
- Any other health problems you may have.
- How severe your pain is.
- The possible side-effects of the medicines.
Paracetamol is normally prescribed if your pain is not too serious and you do not have inflammation.
NSAIDs are generally prescribed for people who have pain and inflammation — for example, if you have pain in your joints (arthritis) or muscles (back pain). This is because there is ly to be some inflammation present and NSAIDs work well to treat pain as well as inflammation.
NSAIDs have a number of possible side-effects and they are not suitable for everyone. For example, they are not suitable for people who have or have had stomach ulcers. In this case a doctor may prescribe a safer medicine (paracetamol) even though it may not work as well.
NSAIDs can be used with heat and ice treatment in joint, muscle or ligament injuries. See the separate leaflet called Heat and Ice Treatment for Pain.
Weak opioids are usually prescribed for more severe pain, or if you have tried paracetamol and/or ibuprofen and they have not worked.
Stronger opioids are normally used to treat severe pain — for example, cancer-related pain, pain after an operation, or if you have had a serious injury.
Anti-inflammatory medicines used as a cream (topical painkillers) are mainly used to treat pain in your soft tissues and muscles. See the separate leaflet called Topical Anti-inflammatory Painkillers for more details.
Dr Sarah Jarvis, January 2021
The National Institute for Health and Care Excellence (NICE) has updated several of its guidances on painful conditions, including low back pain and sciatica.
These highlight some of the risks of side-effects of pain medications, including addiction with strong (opioid) painkillers.
This means your doctor will recommend that you take most painkillers for the shortest time possible, in the lowest dose that is effective. If you have concerns, please speak with your doctor or pharmacist.
People who are in pain all the time are usually recommended to take painkillers regularly. For example, if you have been prescribed paracetamol you will normally take it four times a day, every day until the pain is better. Otherwise, you only need to take painkillers when you need them.
If you are taking an NSAID such as ibuprofen or diclofenac, you will need to take this with or after food. This is because they can irritate the lining of your stomach and sometimes cause bleeding in your stomach.
all medicines, painkillers should be taken for the shortest period of time possible, in the lowest dose that controls your pain. This is to help avoid any side-effects.
Most people only need to take painkillers for a few days (for example, for toothache) or weeks (having pulled a muscle). However, some people have painful conditions and need to take painkillers on a long-term basis.
Examples include people with rheumatoid arthritis, osteoarthritis, or chronic back pain.
It is not possible to list all the possible side-effects of each painkiller in this leaflet. However, as with all medicines, there are a number of side-effects that have been reported with each of the different painkillers. If you want more information specific to your painkiller then you should read the information leaflet that comes with the medicine.
Most people who take anti-inflammatories, at least in the short term, have no side-effects, or only minor ones. When taken appropriately, the benefit usually far outweighs the potential harms.
In particular, many people take a short course of an anti-inflammatory for all sorts of painful conditions. However, side-effects, and sometimes very serious possible adverse effects, can occur. These include bleeding into the stomach and gut, and cardiovascular problems.
See the separate leaflet called Anti-inflammatory Painkillers for more details.
This is a safe medicine and side-effects are rare if you do not take more than the maximum recommended dose. However, paracetamol can be very dangerous if you take too much (overdose).
Overdoses of paracetamol can happen by mistake, but some people intentionally take an overdose.
The main problem with taking an overdose of paracetamol is that it can damage your liver permanently and you can die from this.
The most common side-effects are:
- Feeling sick (nausea) and being sick (vomiting) — particularly at the start of treatment.
- Dry mouth.
Opioids can also cause drowsiness and confusion. Some people can become tolerant to opioid painkillers (needing to take more to get the same effect) and then depend upon them.
This includes opioids that can be bought in pharmacies. If you think you are depending on opioids and need to take higher and higher doses, discuss this with your pharmacist or doctor.
See the separate leaflet called Strong Painkillers (Opioids) for more details.
Some painkillers may interact with other medicines that you might take. This may cause reactions, or reduce the effectiveness of one or other of the treatments. So, when you are prescribed a painkiller, you should tell a doctor if you take other medicines.
You can buy different painkillers, including paracetamol and some NSAIDs (eg, ibuprofen, aspirin and naproxen). However, weaker opioids, such as codeine, are only available to buy in combination with paracetamol or ibuprofen.
The dose of codeine in these combination tablets is lower than the doses your doctor can prescribe for you. It is only possible to buy a few days' supply of the weaker opioid combination tablets.
If you need to take these for more than three days then you will need to discuss this with your doctor or pharmacist.
You need a prescription for weaker opioids that are not in combination with paracetamol — most NSAIDs (for example, indometacin, or diclofenac), as well as stronger opioids (for example, morphine, diamorphine and tramadol) and opioid patches.
It is very rare for anyone not to be able to take some type of painkiller. The main reason why you may not be able to take a painkiller is if you have had a serious side-effect or an allergic reaction to a particular type of painkiller in the past. Even if this happens, your doctor will usually be able to choose a different type of painkiller, which you will be able to take.
Aspirin cannot be taken by children under the age of 16 years, because there is a risk of the child developing Reye's syndrome (very rare).
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication — and/or the leaflet that came with it — with you while you fill out the report.
Pain Relievers: Types, What They Treat, Risks & Complications
Over-the-counter (OTC) and prescription pain relievers treat a variety of problems. OTC drugs ease pain from arthritis, headaches and muscle strains. Prescription painkillers provide stronger relief for chronic pain or severe pain after trauma or surgery. Opioids and some antidepressants and anti-seizure medications also relieve pain.
- Risks / Benefits
- When to Call the Doctor
- Risks / Benefits
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Pain relievers ease discomfort brought on by illness, injury, surgical procedures and chronic conditions. Everyone experiences pain differently. Pain may come on suddenly (acute).
Chronic pain can last for months or years.
Pain relievers go by many names:
- Pain medicine.
What are the types of pain relievers?
There are many different types of pain relievers. The best one for you depends on many factors, including the cause of pain and its severity.
Types of pain relievers include:
- Over-the-counter (OTC): These medications are available at stores. Any adult can buy them.
- Prescription: These medications are only available with a prescription from a healthcare provider. Prescription painkillers provide stronger pain relief. They treat severe or chronic pain.
What are the types of over-the-counter pain relievers?
Common OTC pain medications include:
- Acetaminophen: This drug (Tylenol®) dulls pain receptors in the brain. As a result, you feel less pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs lower the production of prostaglandins. These hormone- chemicals irritate nerve endings, causing inflammation and pain. NSAIDs include aspirin compounds (Excedrin®), ibuprofen (Advil® and Motrin®) and naproxen sodium (Aleve®).
- Combination: Some pain relievers contain both acetaminophen and aspirin (an NSAID). Certain OTC headache medicines also have caffeine.
- Topical: You apply this pain medication directly to your skin. It comes as a cream, gel, spray or patch. Topical medicines block pain receptors in the brain. They may contain aspirin, lidocaine, capsaicin pepper or other medication. Some topical treatments make the skin feel warmer or cooler. Common brands are Aspercreme® and Ben-Gay®.
What do over-the-counter pain relievers treat?
OTC pain medications lower fevers and ease pain from a variety of problems, including:
What are the types of prescription pain relievers?
Prescription pain medications provide stronger pain relief than OTC drugs. Types of prescription pain relievers include:
- Antidepressants: Antidepressants work on chemicals called neurotransmitters in the brain. These drugs work best for chronic pain, including migraines. The largest pain relief comes from tricyclics (Elavil®) and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effexor® and Cymbalta®. Studies show that selective serotonin reuptake inhibitors (SSRIs) Prozac® don’t work as well for pain. SSRIs may make other pain medicines less effective.
- Anti-seizure medications: Medications for epilepsy interrupt pain messages to the brain. Types include gabapentin (Gabarone®) and pregabalin (Lyrica®). These medicines can ease nerve pain and fibromyalgia.
- Muscle relaxers: These medications reduce pain by relaxing tight muscles. They also relieve muscle spasms.
- Opioids: Opioids are lab-made narcotic pain medicines. They change how your brain perceives pain messages. Because they can be addictive, healthcare providers rarely prescribe opioids for chronic pain. You may take opioids for a short time after a surgery or traumatic injury. Codeine, fentanyl, hydrocodone and morphine are all opioids.
- Steroids: Corticosteroids are strong anti-inflammatory drugs. NSAIDs, they stop your body from making chemicals that cause irritation and inflammation. Steroids such as Prednisone® treat migraines and severe arthritis and back pain.
- Topical: Your provider can choose among prescription-strength skin creams, gels, sprays and patches. They can ease muscle pain, arthritis and fibromyalgia. Types include lidocaine (Lidoderm®) skin patches.
What do prescription pain relievers treat?
Prescription pain relievers can alleviate pain brought on by:
OTC pain relievers are relatively safe when you follow the directions on the label. Acetaminophen and NSAIDs can be hard on the liver and kidneys. You shouldn’t take them if you have kidney disease or liver disease.
The risk of liver damage from acetaminophen is higher if you take more than 3,000 milligrams in a day. You may also develop liver problems if you combine the drug with alcohol.
Children under 18 should not take aspirin. It can cause a life-threatening illness called Reye’s Syndrome. Give other NSAIDs instead.
Except for aspirin (which thins the blood), prolonged use of NSAIDs can increase your risk of heart attacks and strokes. People with existing heart problems or high blood pressure are most at risk. If you need NSAIDs for more than 10 days , see your healthcare provider.
NSAIDs can also increase your risk of:
What are the potential risks or complications of prescription pain relievers?
Prescription painkillers are powerful drugs. They carry a higher risk of problems than OTC medications.
Opioids can be addictive and lead to substance abuse. To lower this risk, healthcare providers only prescribe opioids for short-term use. For example, you may take opioids for a few days after surgery.
Prescription medications for pain may cause side effects, such as:
Are pain relievers safe during pregnancy?
Studies suggest that acetaminophen is safer to take during pregnancy. Taking NSAIDs or opioids during early pregnancy may increase the risk of birth defects.
If you had a cesarean section (C-section) birth or a difficult labor and delivery, you may need pain relief. Let your provider know if you plan to breastfeed. Certain opioids are safer for nursing babies. OTC pain relievers are safe to use while nursing.
You should call your healthcare provider if you are taking pain medicine and experience:
A note from Cleveland Clinic
Pain relievers can bring a welcome break from aches and discomforts. You can find acetaminophen and anti-inflammatory drugs in a lot of OTC products. These include medicines for allergies, colds and flu.
It’s important to read the labels to make sure you don’t get too much of a pain medication. Many nonaddictive pain medicines are available for chronic pain.
Your healthcare provider can work with you to find the right medicine to help you enjoy better, pain-free days.
Last reviewed by a Cleveland Clinic medical professional on 04/13/2021.