Pain treatment options

These are pain medications that you take by mouth as a pill, gel tablet or liquid. Oral medications can be divided into two groups — opioids and non-opioids — based on the active ingredients in the drug.

Opioids 

Medications that contain opiates as the active ingredient are strong pain relievers used to treat moderate to severe pain. There are different versions of opiates, and while they can be effective pain relievers, how fast they work, how long the relief lasts and the risk of side effects varies. These are all important issues to discuss with your doctor. Opioids are potent painkillers that can be safe and effective if taken properly for a defined, short period of time. When prescribed or taken improperly or for too long, it’s possible to become dependent on or addicted to opioids. This doesn’t mean that you should avoid them if your doctor prescribes them, but you should talk to him or her about the expectations for how long you should take the medication and when you should reduce your dose. Pain treatment guidelines include the use of opioids, but they also suggest options to reduce their role. The use of opioids, non-opioids and options to minimize opioid use are issues you can discuss with your doctor. Common side effects associated with opioids include nausea, vomiting, drowsiness or constipation. If they arise, they can stop on their own, but if they continue, your doctor can reduce the dose or prescribe a different opioid.

Non-opioids

Non-opioids can be further categorized based on their active ingredient, usually aspirin, acetaminophen or a non-steroidal anti-inflammatory (NSAID) such as naproxen or ibuprofen. Another family of NSAIDs contains a different active ingredient called cyclooxygenase-2 (COX-2)-selective inhibitors. Acetaminophen- and NSAID-based medications are available over the counter (without a prescription); some NSAID treatments require a prescription when greater amounts of the active ingredient are needed. Although over-the-counter medications are generally safe, always follow your doctor’s instructions. NSAID medications have the potential to cause stomach irritation and carry other risks depending on your medical history, which is why your complete medical and medication history is an important part the conversation with your doctor. There are also potential risks associated with acetaminophen. Other non-opioid pain treatments used to manage post-op pain include gabapentin, a treatment for epilepsy, and pregabalin, which is used to manage nerve pain in people with diabetes. Both are categorized as anticonvulsants, not NSAIDs.

With PCA, a computerized pump delivers pain medication intravenously when you press a button that controls the pump. The pump is programmed to deliver a specific amount of the medication even if you press the button many times, to help avoid administering too high of a dose, which can be dangerous. It’s important that only the patient, not a caregiver, controls the pump. The type of medication delivered will be determined by your healthcare team, but PCA is commonly used to administer opioids.

Prior to or after surgery, a catheter (a very thin, hollow tube) is inserted into the back so that pain medication can be delivered to the area directly near the nerves that carry the signals that create the sensation of pain.

Like PCA, the patient controls delivery of the pain treatment. With epidural analgesia, a pain medication is delivered directly to the nerve area near the spine; with intravenous PCA, the pain treatment gets to the nerves via the bloodstream. Epidural PCA can provide rapid relief because the medication is delivered directly near the nerves. The type of medication delivered will be determined by your healthcare team.

The table below provides a brief summary of common pain medications, how they’re administered and their common side effects. If you’d like more detailed information about drugs to manage pain, the drug search page at MedlinePlus is a helpful resource. But always discuss any treatment questions with your doctor.

Source: American Society for Enhanced Recovery. Please see Full Prescribing Information for Safety Information

During or after surgery, an anesthetic can be injected into the surgical site to numb the area and provide local pain relief in the area where the surgery occurred for anywhere from a few hours to a few days after the procedure. If your surgeon wants to prolong the effect, he or she may administer a long-lasting version that slowly releases the numbing medication over time to last as long as the most severe postsurgical discomfort.

Prior to surgery, an anesthetic can also be injected into an area with bundles of nerves (such as near the spine) that transmit pain signals from a broader section of your body to provide regional pain relief. The procedure called epidural anesthesia delivers the anesthetic just outside of the fluid-filled sac that surrounds the spinal nerves. When the anesthetic is delivered into the sac, the technique is called spinal anesthesia.

Nerve block is a term used to describe the injection of anesthetics near a cluster of nerves to numb the appropriate area of your body extremity (arm, leg, head) that requires surgery. This is a form of regional pain management.