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Chronic Pain: OTC or Prescription Medicine?

Don’t Underestimate Side Effects continued...

If you need an NSAID for longer than 10 days, check with your doctor to see if you need a prescription NSAID or some other alternative. Also ask if you need to take extra steps to help protect your stomach.

Acetaminophen carries a risk of liver damage, which can lead to liver failure, if not taken as directed. Make sure you take no more than recommended on the label. And watch out that you do not mix it with other medications, including prescription painkillers that may also contain acetaminophen. The risk of liver damage increases if you drink alcohol. In fact, the FDA recommends that you do not mix acetaminophen with any alcohol.

The strength of a pain reliever also matters when it comes to side effects. That’s why it’s important to avoid taking more than the recommended amount of an OTC pain reliever.

"If you are feeling better, consider decreasing the frequency or dosage of any pain medicine," says Minzter. "Give your body an occasional vacation from pain drugs.” But remember, when it comes to OTC pain relievers, you shouldn't take them for more than 10 days without talking to your doctor.

 

Prescription Drugs: Not Always the Next Step

If OTC drugs are not effective in relieving your pain, moving to a prescription drug is not always necessarily the next step. In many cases, drugs may not always be the best course of treatment.

"Pain management doesn’t have to involve a drug," Minzter tells WebMD. Non-medication approaches include avoiding certain activities, exercising, heat or cold applications, weight management, bioelectric currents, complementary and alternative medicine, and surgical procedures.

But if you and your doctor decide that prescription medications are the way to go, there are plenty of options.

Many prescription drugs are designed to treat chronic pain, including back and neck pain, headaches, nerve pain, fibromyalgia, rheumatoid arthritis, and osteoarthritis. The following are a few examples:

Antidepressant Medications

Over the years, doctors have discovered that antidepressants actually help with certain types of pain, such as:

  • Nerve damage caused by diabetes or shingles
  • Tension headache and migraine
  • Fibromyalgia
  • Back pain

Doctors have found that tricyclic antidepressants are helpful in easing pain and may also improve sleep. While researchers aren’t exactly sure how they reduce pain, studies suggest that tricyclic antidepressants boost chemicals in the brain that help diminish pain signals.  

Some examples of tricyclic antidepressants that may relieve pain include:

  • Amitriptyline
  • Desipramine (Norpramin)
  • Doxepin
  • Imipramine (Tofranil)
  • Nortriptyline (Aventyl, Pamelor)

Other types of antidepressants called SNRIs (serotonin and norepinephrine reuptake inhibitors) that may help relieve pain include:

  • Desvenlafaxine (Pristiq)
  • Duloxetine (Cymbalta)
  • Milnacipran (Savella)
  • Venlafaxine (Effexor)

Other antidepressants known as SSRIs (selective serotonin reuptake inhibitors) may be used to treat the depression that often accompanies chronic pain. This, in turn, also may help relieve pain.

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