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Medication for chronic pain

medicine trialSome people with chronic (persistent) pain try medication, and for some people they work. But they're only a small part of the treatment for chronic pain.

People often overestimate how well medications will work and underestimate how much self-care techniques can help. Self-care techniques are often the most effective way of treating chronic pain. It can take time and effort to practise them, and you may not notice them working immediately. But they're likely to gradually lessen your pain over time.

Medications often don't work well for chronic pain or only work for a short time. They also have side effects that you have to consider.

It's quite common to try some medications, while your doctor monitors how much they help you. It's also common to try stopping all medication for a while to see what happens.

Unless it's clear that a medication is helping you, you don't want to take it long-term.

Paracetamol

Paracetamol is a simple pain reliever that can help in some chronic pain conditions such as arthritis. As long as you take it as prescribed, it's very safe with few side effects. But it's unlikely to help much with nerve (neuropathic) pain.

Non-steroidal anti-inflammatories (NSAIDs)

NSAIDs like ibuprofen, diclofenac and naproxen can be effective in reducing pain and inflammation. But if you use them for a long time, they can cause complications, such as kidney, stomach and heart problems. You shouldn't take this type of medication for more than a week unless your GP is supervising your treatment.

Antidepressants

You might be confused if your doctor suggests trying an antidepressant like amitriptyline, nortriptyline or venlafaxine to treat your pain. But it isn't because they think the pain is all in your head or that you're depressed. Tricyclic antidepressants block the signals that overactive nerves send out, which can make them effective in treating nerve (neuropathic) pain.

These medications can cause drowsiness, so people usually take them at night, which can also help if the pain is disturbing your sleep. But they can also cause a dry mouth.

If your doctor has prescribed an antidepressant, it's important to give it time to work. Some people notice a difference in just a few days, but it can take several weeks to work. It's best to try this for at least four weeks to see if it's working.

Anti-epileptic medication

Some epilepsy medications like gabapentin and pregabalin can treat chronic nerve pain by blocking nerve impulses. It's best to start this type of medication at low doses and gradually increase it until the right dose is found. This means it can take a while to start working so it's important to keep taking it.

Topical treatments

Topical treatments are treatments you put directly on your skin.

Capsaicin cream (Zostrix)

Capsaicin cream blocks the nerves causing pain. Usually, you'll first feel a warm, almost burning sensation but this quickly eases. If the cream irritates your skin, stop using it and see your GP. DermNet NZ – Capsaicin has more information about capsaicin cream.

Lignocaine gel

This is a local anaesthetic gel that can help block the nerves causing pain.

Opioid pain relievers

pp opiatesStrong pain relievers like codeine, morphine, oxycodone and tramadol can effectively treat severe short-term (acute) pain. Morphine and oxycodone are the strongest opioids.

But studies suggest these medications aren't effective for chronic pain in the long-term.

Even if you're having a short-term flare-up of your pain, doctors don't recommend you use them. This is because opioid pain relief medicines can have significant side effects and cause some important long-term harm.

If you're prescribed opioids, it's important to take them exactly as they're prescribed.

Prescriptions for these medicines are closely regulated. Your GP will need to see you regularly to monitor how well the medication is working and make sure they're aware of any problems.

They may ask you to sign an agreement outlining your pain-relief goals and a plan for your prescriptions. Try not to be offended by this process, as it's there to make sure you use these medicines safely and appropriately and get the best treatment possible.

Medical cannabis

New Zealand and Australian pain specialists don't endorse or recommend using cannabis for chronic non-cancer pain. This is because there's little proof it's effective in treating chronic pain and it has several damaging side effects.

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Written by HealthInfo clinical advisers. Last reviewed August 2021.

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Review key: HICHP-79018