The goal of pills, patches, and creams is to take the pain down a couple of notches to allow for exercise, work, and socializing—activities vital to recovery. But set realistic expectations, says Clauw, the University of Michigan pain doctor, and always start with the safest option in the lowest dose that’s helpful.
The risks of more potent drugs, such as opioids, often outweigh the benefits. “In the best-case scenario, one-third of people taking any single drug will reduce their pain level by half,” Clauw says. Most get far less relief.
There’s no solid data supporting most pain-relief supplements, including glucosamine and chondroitin. Marijuana may relieve certain types of pain. And though little research has been done in humans, preliminary findings suggest that cannabidiol (CBD), a cannabis compound found in marijuana, can reduce inflammation, which could alleviate pain. (See “CBD Goes Mainstream,” from the May 2019 issue of CR.) Fish oil reduces inflammation and helps some with rheumatoid arthritis pain. Research has linked vitamin B and D deficiencies to certain types of pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve and generic), work primarily by reducing painful swelling. Acetaminophen (Tylenol and generic) reduces your brain’s perception of pain. NSAIDs are typically better for muscle and joint pain, Tauben says; neither is very effective against nerve pain, such as that from shingles.
NSAIDs can be powerful. A 2017 JAMA study showed that patients who received ibuprofen plus acetaminophen for severe pain reported the same amount of pain reduction as those who received an opioid plus acetaminophen. Always check with your doctor before combining any drugs, taking more than the recommended dose, or continuing an OTC drug for longer than 10 days.
Side effects for ibuprofen can include heart attack or stroke, stomach bleeding and kidney disease; for acetaminophen: liver disease.
Topical Pain Relievers
Pain relievers in cream or patch form—OTC or prescription—may cause fewer side effects than pills because less of the drug is absorbed into the bloodstream. Their ingredients can help in one of three ways: by reducing pain and inflammation (NSAIDs or aspirinlike compounds called salicylates), by producing a feeling of heat or cold to keep nerves busy transmitting those sensations instead of pain (chili-pepper-derived capsaicin or cooling menthol), or by numbing the area (lidocaine).
“They can provide some relief from mild to moderate pain but not enough for severe symptoms,” Tauben says.
Antidepressants. The only antidepressant approved for treating certain types of pain is duloxetine (Cymbalta and generic). But for years, doctors have prescribed other antidepressants off-label. Small doses can help with fibromyalgia, headache prevention, and pain due to nerve damage. The drugs affect brain chemicals that regulate pain and mood, so they can help even in people who aren’t depressed. But they can come with side effects, such as weight gain, constipation, and suicidal thoughts.
Anti-convulsants. Three drugs used to prevent seizures are also FDA-approved—and increasingly prescribed—for certain types of nerve pain: gabapentin (Neurontin and generic), pregabalin (Lyrica), and carbamazepine (Epitol and generic), which can cause deadly allergic reactions. Studies suggest they help with nerve pain but not common ills such as back pain. Side effects can include suicidal thoughts.
Muscle relaxants. Drugs such as cyclobenzaprine (Amrix and generic) can be useful against a pain flare-up. But there’s no evidence that taking them longer than three weeks is helpful, and feeling groggy can hinder recovery, Clauw says. Avoid carisoprodol (Soma) because it carries a high risk of abuse and addiction. And never take these alongside opioids.
Opioids. These drugs—which include codeine, oxycodone (OxyContin), and hydrocodone, and are sometimes combined with acetaminophen (Vicodin, Percocet)—should be considered only if no other treatments work and only if there are more benefits than risks for an individual patient, according to the American College of Physicians. They work well in the short term for severe pain from an injury or from surgery but not against chronic pain because they often lose effectiveness over time, can increase sensitivity to pain, and carry risks of addiction and overdose. Possible side effects include constipation, breathing problems, confusion, irritability, and sedation.