What are some types of pain medication?

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People may find three types of pain medications OTC:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Some NSAIDs that people can try without a prescription include:

• ibuprofen (Advil)
• acetylsalicylic acid (Aspirin)
• low dose naproxen (Aleve)

NSAIDs reduce pain from inflammation. They work by blocking an enzyme in the body that produces prostaglandins. These natural chemicals influence how people perceive pain. Prostaglandins also have associations with muscle and bone pain. So, blocking the production of prostaglandins tends to help relieve pain in some people.

Common side effects of NSAIDs include:

• nausea
• upset stomach
• other gastrointestinal disturbances
• high blood pressure

Acetaminophen

Acetaminophen is a non-opioid pain reliever. People use acetaminophen (Tylenol) for mild to moderate pain. They are sometimes used in combination with other pain relievers. However, experts do not yet know how acetaminophen helps treat pain.

For severe pain, acetaminophen is less useful.

Side effects of acetaminophen are:

• rash
• allergic reaction
• certain metabolic disorders, such as low sodium levels in the blood and low red blood cell count

Typically, acetaminophen is safe when used correctly. The maximum dose is 4000 milligrams (mg) in 24 hours, taking more can lead to severe liver damage.

Topical analgesics

People use topical analgesics to treat local pain without taking a pill by mouth. Topical agents are applied to the skin at the location of the pain.

For example, doctors may recommend diclofenac gel for muscle pain from strains and sprains. Like oral NSAIDs, some people may have stomach bleeding with diclofenac gel. However, this is a rare side effect.

People may relieve muscle, joint, and tendon pain by rubbing topical salicylate into the skin. They work by causing irritation in the skin, a mechanism used to counteract the sensation of pain.

Topical capsaicin is another agent people can apply to the skin for pain relief. It works by attaching to pain receptors on the skin that have a role in pain signaling. By sticking to the pain receptors and keeping them occupied, the receptors lose their function and stop signaling pain.

Some people use capsaicin for pain caused by herpes zoster virus or shingles. People with osteoarthritis may benefit from using capsaicin. This topical medication is usually safe but may cause a rash or itching on the skin.

Each medication works in a different way to treat pain:

Prescription NSAIDs

Certain NSAIDs are only available through a doctor’s prescription. They work in the same way as NSAIDs. Examples of common NSAIDs doctors may prescribe include:

• oral diclofenac (Zipsor)
• meloxicam (Mobic)
• celecoxib (Celebrex)

People who need prescription NSAIDs may be experiencing inflammation and mild-to-moderate pain.

While the side effects of prescription NSAIDs are similar to over-the-counter NSAIDs, they can be more severe. A doctor must first authorize its use by assessing a person individually. They may also monitor people closely while taking prescription NSAIDs.

Antiacid medications may need to be taken with some prescription NSAIDs, and this is to counteract some of the gastrointestinal side effects. If people are experiencing any gastrointestinal symptoms, they should talk with their doctor before starting antacids.

Tramadol and opioids

Opioids include medications that resemble the natural plant alkaloids found in opium. Examples of opioid drugs include:

• morphine (MS Contin)
• oxycodone (Oxycontin)
• fentanyl patch

These are the most effective medications to relieve severe pain. Doctors prescribe the lowest effective dose for the shortest duration because of the risks of taking opioids.

Some side effects of opioids include:

• extreme changes in mood
• heavy sleepiness
• constipation
• nausea and vomiting
• trouble breathing

People can also develop a tolerance and addiction to opioids.

Tramadol (Ultram) is a drug called an opioid agonist, but it acts differently than opioids. Both opioids and tramadol block certain receptors, which help treat pain. Tramadol acts on neurotransmitters, specifically norepinephrine and serotonin.

Corticosteroids

Doctors reserve corticosteroids for flare-ups of long-term pain conditions, such as rheumatoid arthritis.

Corticosteroids are effective in reducing inflammation that leads to pain. However, its use is limited due to side effects. Side effects can depend on the dose and duration of treatment.

Some side effects of corticosteroids can include:

• upset stomach
• stomach ulcers
• osteoporosis
• fractures
• diabetes
• adrenal insufficiency

Antiseizure medications

Doctors may sometimes prescribe antiseizure medications for pain. These may include:

• gabapentin (Neurontin)
• pregabalin (Lyrica)
• carbamazepine (Tegretol)

Antiseizure medication reduces the release of chemicals in the brain, called neurotransmitters, that signal pain. Doctors may prescribe these antiseizure medications for specific types of nerve pain.

The most common side effects of antiseizure medications include:

• dizziness
• sleepiness
• fluid buildup in the legs
• suicidal thoughts and behaviors

Each antiseizure medication has its own specific side effect profile. For example, gabapentin may cause confusion in some.

Antidepressants

Amitriptyline and duloxetine (Cymbalta) are two common antidepressants that doctors may prescribe for various types of pain. These can include:

• chronic pain
• nerve pain
• long lasting muscle and bone pain

Some people take antidepressants to prevent migraine or tension headaches.

Like antiseizure medications, antidepressants act on different neurotransmitters to help treat pain. Noradrenaline and serotonin — which are involved in mood and pain disorders — are two neurotransmitters they act on.

Some side effects of antidepressants include:

• nausea
• constipation
• headache
• suicidal thoughts and behaviors

It is important to treat pain during pregnancy. When left untreated, pain can cause depression and high blood pressure during pregnancy. A doctor can best advise on the appropriate medication and dosing that is safe for pregnant people.

Acetaminophen is the most common medication to treat pain during pregnancy. Pregnant people can take the usual adult dose throughout pregnancy.

Also, most NSAIDs are appropriate for mild to moderate pain during the first and second trimesters. Doctors recommend avoiding NSAIDs in the third trimester because of the risks it poses. For example, NSAIDs may lead to changes in blood flow between mother and child.

Doctors may also recommend short term-use of weak opioids, such as codeine and morphine. Neonatal abstinence syndrome is a risk when fetuses become exposed to opioids later in the pregnancy. Doctors will closely monitor the baby during the third trimester if opioid treatment is necessary.

Some other pain medications that may be safe during pregnancy include:

• pregabalin (Lyrica)
• gabapentin (Neurontin)
• amitriptyline

People respond to pain differently since tolerance varies. If OTC medications are not providing significant relief, talk with a doctor. Depending on their pain assessment, they can prescribe appropriate prescription pain relievers.

Once starting a prescription pain reliever, it is important to follow up with a doctor to ensure the treatment works and is not causing too many bothersome side effects.

Managing pain when it is addressed early usually makes it easier to treat. Putting off going to the doctor is not helpful as feeling pain can affect a person’s quality of life. Managing pain may sometimes require a network of different healthcare professionals.

People with medical conditions or other circumstances that impact the safety of using pain relievers, should speak with a doctor before taking any medications.

Different pain medications treat various pain disorders because they work in different ways. They each have their indications and side effects. Some are available over the counter, such as acetaminophen (Tylenol), while others require a prescription.

To find the most appropriate pain medications, consult a doctor or pharmacist.