The goal of treating chronic pain with medicines is to reduce pain to a level that allows you to improve your functioning and quality of life.1,2 Medicines to treat pain are generally divided into opioids and non-opioid medicines.3 Opioids (eg, morphine, codeine, endone, etc) are used to treat severe acute pain or cancer pain,4 but are often not very effective in chronic pain that is not caused by cancer.5
Non-opioid pain medicines can be effective at relieving pain,3 but should generally be used only for a short period and only for as long as they are helping to manage your pain so that you can maintain physical and social function.2
- It is unlikely that any pain relievers will be able to completely stop chronic pain.6,7 A multidisciplinary approach to management has been shown to be more effective for chronic pain than relying on pain relievers alone.8
- Medication is best used alongside other non-drug approaches as part of multimodal management of pain.1
- Pain medicines do not work for all patients, and often don't remove pain completely when they do work.5
- All medicines have side effects and before prescribing a medicine for chronic pain, your doctor will discuss its potential benefits and harms, to help decide whether the medicine may be useful for you.2
Types of non-opioid medicines for chronic pain
Non-opioid pain relievers that are commonly used as part of a pain management plan are paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).3
Paracetamol can be effective for mild chronic pain or to supplement other medicines. It is important not to take more than the recommended dose.2,3
Non-steroidal anti-inflammatory drugs (NSAIDS)
In many cases of chronic pain, inflammation is not the cause, so anti-inflammatory medicines may not be helpful. NSAIDS may be able to give short-term relief during a pain flare-up, but generally they should not be used for long-term pain relief because of the risks associated with them. In cases where long-term NSAIDs may be the best option, you will be treated under the ongoing supervision of your doctor. NSAIDS can interact with other medications and you should discuss your medicines with your doctor or pharmacist.1,3
Low doses of medicines normally used to treat depression (antidepressants) called tricyclic antidepressants can have a pain relieving effect for several types of chronic pain, including neuropathic (nerve) pain. However, these medicines can have side effects (eg, a persistently dry mouth) which can be hard to tolerate.1,9
Another type of antidepressant called a serotonin and noradrenaline reuptake inhibitor (SNRI), can be also effective in some types of neuropathic pain.1
The doses of antidepressant medications used to treat pain are usually lower than those used to treat depression.10
A detailed review of clinical research trials shows that some medicines originally developed to treat epilepsy, known as antiepileptic medicines, may provide pain relief in some, but not all, people with specific neuropathic pain conditions such as painful diabetic neuropathy, postherpetic neuralgia and central neuropathic pain.11
Antidepressants and anticonvulsants/ antiepileptics are prescription medicines. Do not take them unless they have been prescribed for you. Always follow the instructions provided by your prescriber or pharmacists.
For more information, see the Consumer Medicine Information (CMI) for your brand of medicine, available on our Medicine Finder page or from your pharmacist or doctor.
- Cohen ML. Principles of prescribing for persistent non-cancer pain. Aust Prescr 2013;36:113–5. [Online]
- Pain Australia. Fact sheet 7: Managing chronic pain. Waverly, NSW: 2014.
- Hooten WM, Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement, November 2013.
- McNicol ED, Midbari A and Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev 2013;29.
- Turk DC, Wilson HD and Cahara A. Treatmnent of chronic non-cancer pain. Lancet 2011;377:2226–35. [Pubmed]
- Siddall PJ, McCabe R and Murray R. The pain book: finding hope when it hurts. Sydney, Australia: Hammond Press, 2013.
- Therapeutic Guidelines. Key points for patients about chronic pain. Melbourne, Victoria: Therapeutic Guidelines Limited, 2011.
- Australian and New Zealand College of Anaesthetists. National pain strategy: pain management for all Australians. Melbourne: ANZCA, Faculty of Pain Medicine, Australian Pain Society, Chronic Pain Australia, 2010. [Full text] (accessed 11 May 2015)
- Fishbain D. Evidence-based data on pain relief with antidepressants. Ann Med 2000;32:305–16.
- Holliday S, Hayes C and Dunlop A. Opioid use in chronic non-cancer pain-part 2: prescribing issues and alternatives. Aust Fam Physician 2013;42:104–11.
- Wiffen PJ, Derry S, Moore RA, et al. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev 2013;11:CD010567.