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Pain: it’s one of the most common complaints for Americans of all ages today. From tension headaches to more serious disorders like arthritis, dealing with and alleviating pain is often one of the biggest challenges medical professionals face. Overtreating and undertreating are both potentially dangerous; pain is the body’s way of telling us that something is wrong. However, undertreating it can lead to brain fog, issues with concentration, anxiety, depression, and even an inability to focus on and complete everyday tasks. Migraineurs know this affect very well; sometimes it hurts just to look at the screen.
Unfortunately, many of the best pain management medications come with serious side effects like addiction, increased blood pressure, or increased strain on the liver. It’s very difficult to find solutions that balance safety with the need for pain control–but that doesn’t mean it’s completely impossible. These five non-addictive pain management medications are not only safe for the majority of patients, but are remarkably effective at reducing aches and pains, too.
Important: Although the pain management medications listed here are relatively safe, you should always consult your pharmacist or physician before starting a new medication. This is especially true if you suffer from pre-existing health conditions. Always be safe!
Anticonvulsants
Anticonvulsants first came to fame for treating epilepsy, but as it turns out, they have an unintended consequence: most also seem to reduce neuropathic pain levels. This class of drugs isn’t addictive, though they can carry certain bothersome side effects. Titrating the dose upward from a very small dose to the average daily dose ameliorates most of these side effects, as does weaning the dose down slowly.
Drugs that fall into the anticonvulsant family include:
- Lyrica
- Gabapentin
- Depakote
- Lamictal
- Tegretol
How do Anticonvulsants Work?
Anticonvulsants work by impacting both calcium channels and GABA levels in the brain, both of which have a direct impact on pain in the body. By influencing these brain chemicals, they reduce pain signals, causing your brain to interpret them as being less severe than they really are. They are best used in tandem with other pain management medications or treatments.
When are Anticonvulsants Indicated?
Anticonvulsants do show efficacy in many conditions, but they aren’t right for every kind of pain. They are most effective for conditions that bring on neuropathic (nerve) pain, including:
- Herpes viruses
- Shingles
- Diabetes-related neuropathic pain
- Multiple Sclerosis
- Sciatica
- Spinal degeneration
- Fibromyalgia
- Myalgic Encephalomyelitis
- Peripheral neuropathy
These pain management medications do require a prescription, and many also necessitate regular blood work, too. Getting the right level is important; too much can cause drowsiness, while too little is ineffective. That said, the vast majority of patients experience few to no side effects if the dose is titrated correctly. See your physician if you have questions about whether they’re right for you.
SNRIs and SSRIs
Officially known as “Selective Norepinephrine Reuptake Inhibitors” (SNRIs) or “Selective Serotonin Reuptake Inhibitors,” (SSRIs), these two drug categories are most commonly known as antidepressants. They can significantly improve mood for people with clinical depression, and show marked efficacy in treating chronic pain conditions, too. A few of the most common drugs in this category include:
- Effexor
- Cymbalta
- Zoloft
- Prozac
- Celexa
How do SNRIs and SSRIs Work?
Each of these drugs influences serotonin and norepinephrine in the brain, both of which impact how and when the body experiences pain signals. Much like anticonvulsants, they can reduce the perceived severity of pain so you can better focus on everyday tasks. They may also reduce the risk of chronic pain-associated depression, too.
When are SNRIs and SSRIs Indicated?
As some chronic pain patients experience depression and/or anxiety after extended bouts with pain, some doctors are proactive about treating pain with SNRIs and SSRIs. Others prefer to use it only when the ability to treat pain exceeds over-the-counter options. Both are most commonly used to treat these conditions:
- Fibromyalgia
- Multiple Sclerosis
- Migraines
- Diabetes-related neuropathic pain
- Tension headaches
- Cervicogenic headaches
- Lower back pain
- Spinal cord injuries
- Certain traumatic brain injuries
SNRIs and SSRIs aren’t addictive, but they may not be right for everyone. They are contraindicated in patients with a history of suicidal thoughts and those with bipolar disorder. They also cannot be taken with MAO inhibitors, other serotonin-boosting drugs, or pain drugs like Tramadol that may also have a weak effect on serotonin levels. Your doctor can help you to calculate the best dose for your condition.
Tricyclic Antidepressants
Tricyclic antidepressants share the same ability to reduce pain as SNRIs and SSRIs; they change the levels of certain brain chemicals to reduce how your body interprets pain. Unlike the previous two drug classes, tricyclics are older, better studied, and may be better tolerated in certain patient populations. They are also more effective at treating certain pain conditions (like migraines). Tricyclics often cause sleepiness and are most frequently prescribed at bedtime, and may help you to achieve a better sleep at night, too.
Drugs that fall into the tricyclic family include:
- Amitriptyline
- Nortriptyline
- Norpramin
- Doxepin
- Tofranil
- Protriptyline
Some people seem to naturally respond better to certain analogues, so you may need to try one or two versions before you see results. You should expect full efficacy to take between two and four weeks, though many patients experience a reduction in pain in just a week when taking these pain management medications.
How do Tricyclic Antidepressants Work?
Tricyclic antidepressants work by directly increasing the levels of norepinephrine and serotonin, but they also block a chemical known as acetylcholine, too. It’s the latter effect that probably results in better results for people who don’t respond to treatment with SNRIs or SSRIs. Most researchers agree that achieving balance between these three brain chemicals is one of the best ways to reduce pain.
When are Tricyclics Indicated?
Tricyclic antidepressants are remarkably safe and effective, even in sensitive populations like the elderly or liver-compromised. They’re also very easy to scale, so the dose can be reduced or increased in very small increments. However, they can cause confusion or a worsening of symptoms in people with dementia or other neurological disorders. They are most effective for these conditions:
- Migraines
- Chronic daily headache
- Fibromyalgia
- Multiple Sclerosis
- Rheumatoid Arthritis
- AIDS-related neuropathies
- Diabetes-related neuropathic pain
- Shingles and/or chickenpox
- Other nerve pain disorders
- Osteoarthritis, in tandem with anti-inflammatories
Because tricyclics are an older class of drugs, we know more about them and how they act in certain patient populations. This may make them safer, too. Some doctors provide them solely for the fact that they improve sleep in patients who struggle with painsomnia.
Topical Anti-Inflammatories
Just a decade ago, the primary way to take non-steroidal anti-inflammatory drugs (NSAIDs) was via oral ingestion or intramuscular injection. While remarkably effective for conditions like arthritis and soft tissue injury, these drugs can also have very serious side effects on the gastrointestinal tract.
NSAIDs are commonly associated with stomach and duodenal ulcers, and may also cause a condition known as Barrett’s Esophagus–erosion of the esophagus that may increase a patient’s risk for cancer. These risks are significantly lowered to almost negligible amounts if you’re taking them only once in awhile. Take them daily for long periods of time and the risk increases. That’s why researchers came up with topically-applied NSAIDs like Voltaren Emulgel.
Drugs that fall under topical NSAIDs include:
- Diclofenac
- Ibuprofen
- Ketoprofen
These are the only three NSAIDs to be officially approved for topical use in America at this time. By far, the most common brand is Voltaren Emulgel. Voltaren is applied directly to the area in pain and rubbed in deeply. Though relief is temporary, it can be an excellent adjunct to other treatments.
In some areas of the United States, topical NSAIDs may be available over-the-counter. You should still speak with your pharmacist to verify whether they’re safe for you to use.
Toradol/Ketoralac
For patients in whom narcotics are contraindicated, yet they are experiencing severe pain, Toradol may be the answer. It is an exceptionally strong NSAID-class drug with a proven ability to reduce pain related injury, post-surgical pain and swelling, and visceral or cancer-related pain, too.
Unfortunately, Toradol’s strength isn’t only in efficacy, but in side effects, too: it can seriously injure the lining of your stomach if the recommended dose is exceeded. Most doctors will not prescribe Toradol more than four days at a time, or for breakthrough pain, for this reason.
How does Toradol Work?
Toradol works in the body in a similar way to all other NSAID-class drugs; it blocks the production of inflammation-causing chemicals in the body. Officially, it is a cyclo-oxygenase (COX) inhibitor. In the body, COX plays a role in triggering the body to respond to injury, increasing circulation and swelling in the area to help heal you. That’s desired in minor injuries, but can complicate healing in chronic or long-term conditions.
When is Toradol Indicated?
Toradol is rarely used as a first-line treatment for chronic conditions due to its side effect profile. It is most commonly used for presurgical pain, intense breakthrough pain, dental pain, and other forms of acute injury. It may be appropriate for migraines if taken only seldomly. Side effects and risks are reduced when the drug is taken infrequently, so always follow your doctor’s treatment recommendations.
The pain management medications listed here are non-addictive and remarkably effective, but that doesn’t make them right for every patient or every condition. The best way to approach unresolved pain is to speak with your pharmacist or physician and get to the root of why it’s occurring. Once you begin to understand the cause of your pain, you can work towards relieving it from all possible avenues, including taking pain management medications. Wellness in the event of chronic or acute pain is possible!