The Smart Patient's Guide to
Chronic Pain Management

Non-Opioid Medication Guide. Do You Know the Difference?

Believe it or not, there are currently more than 200 different medications for pain and only 20 are opioids. PPM spoke with Mena Raouf, PharmD, about other medication options for treating chronic pain.

For many reasons, opioids are not the first choice for chronic pain management. "Over time opioids can become less effective as patients develop tolerance and require higher doses to get the same amount of pain relief, and higher doses come with side effects," says Mena Raouf, PharmD, a PGY-2 pain and palliative care resident at the Stratton Veterans Administration (VA) Medical Center in Albany, New York.

Side effects of opioids can include: constipation, abdominal distension, respiratory depression, physical dependence, headaches and low testosterone. One common but often overlooked side effect of long-term opioid use is testosterone deficiency which can supress testosterone production and cause fatigue, sexual dysfunction, loss of bone and muscle mass, mood changes, and overall reduced sense of well-being.

"Testosterone deficiency can ultimately worsen pain symptoms and the underlying disease causing the pain," Dr. Raouf explains. "So a patient with hip arthritis who becomes testosterone deficient can be at greater risk for hip fracture due to the resulting decrease in bone mass. It's important to note women can also be affected by this problem and may experience reduced sex drive."

There are two types of pain—nociceptive pain and neuropathic (nerve) pain. Each type responds to different types of medications.

When the body is injured by a cut or a burn, pain signals are transmitted from the site of the injury to the brain and inflammation results. This is nociceptive pain which is often described as sharp, aching, or throbbing pain. Forces inside the body, such as a tumor, can also cause nociceptive pain.

Neuropathic, or nerve pain, occurs when a nerve sends pain signals when there is no tissue injury or damage around it. In this case, the dysfunction is in the “pain messenger” which is the nerve. This can be caused from damages to the nerves from diabetes (diabetic neuropathy), shingles (post-herpetic neuralgia), alcoholism, or compression of nerves (as with spinal stenosis). Neuropathic pain is described as shooting, burning, or tingling. It can also result in numbness.

Neuropathic pain doesn't respond to anti-inflammatory medications and opioids generally do not target it either. Antidepressants and antiepileptics (also known as antiseizures or anticonvulsants) can be prescribed—even if you aren't depressed or don't have seizures—as they work to block or slow down the pain messages being sent to the brain and, in essence, “calm down” the nerves.

Beyond Opioids: 8 Other Types of Medication Treat Chronic Pain

Non-opioid pain medication is an alternative way to treat chronic pain. There are 8 categories of this type of medication:

  1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
  2. Acetaminophen
  3. Antidepressants
  4. Antiepileptics
  5. Steroids
  6. Topicals
  7. Muscle Relaxants
  8. Tramadol
Printable, Easy-to-follow Medication Guide

Some of the medications listed in the chart (i.e. Ben Gay, a topical; Aleve, an NSAID) are available over the counter (OTC). It's important to understand that OTC medications also have risks. Too much acetaminophen (Tylenol) can cause liver problems; excess amounts of NSAIDs like ibuprofen (Advil) are associated with intestinal problems, heart attacks and stroke.

"If you're already taking a prescribed NSAID, be very careful with OTC cold and allergy medications since many contain ibuprofen or aspirin," warns Dr. Raouf. "One of our patients sprained an ankle and urgent care advised her to take naproxen for the pain but she was already taking a prescription-strength NSAID. Fortunately, the patient was aware of the drug doses and a potentially-dangerous interaction was averted."

Dr. Raouf's anecdote illustrates a problem created by using more than one pharmacy. "When you fill your prescriptions at the same place there is a data base that can help alert you to problems," he says. "Things gets muddy when patients use multiple pharmacies with multiple data bases or when veterans go outside the VA for care. That's when the left hand doesn't know what the right hand is doing."

Always consult your local pharmacist to be sure. “Pharmacists are a wonderful resource but patients tend to overlook them,” admits Dr. Raouf. “It’s often easier to get a pharmacist on the phone or speak to one directly. Pharmacists really are a great source of information about medications and their various reactions and interactions.”



Updated on: 04/29/19
Continue Reading:
The PPM Guide to Relieving Pain Without Medication