Opioids like oxycodone, hydrocodone, and morphine have long been considered some of the most helpful drugs for managing acute pain. However, rates of opioid abuse and overdose deaths have skyrocketed in recent years. And now it turns out that there’s another reason to avoid opioids: they may not be the most effective treatment for pain relief after all.
Do opioids work better than other pain relievers?
Not necessarily. Depending on how much you take, what kind of pain you are trying to treat, and what side effects you prefer avoiding, certain pain relievers may be a better choice than others.
For example, a study in the Journal of the American Medical Association suggests that opioid drugs are no more effective than a combination of non-opioid painkillers in treating acute pain. In the study, 416 emergency room patients with moderate to severe pain were assigned to one of four treatments.
The first three groups got an opioid (oxycodone, hydrocodone, or codeine) along with 300 mg of acetaminophen (Tylenol). The fourth group got 400 mg of ibuprofen, a popular non-opioid, over-the-counter pain reliever plus 1000 mg of acetaminophen. All four groups experienced the same levels of pain relief.
So, what are other options for pain relief?
1) Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs, or non-steroidal anti-inflammatory drugs, are usually considered to be the first line of defense for acute pain, especially pain that doesn’t respond to other non-drug treatments. They also lower fevers and reduce inflammation.
They’re available over the counter (OTC) or by prescription, as brand-name drugs or as generics like ibuprofen, naproxen, or aspirin. Popular over-the-counter brands includeAdvil, Motrin, Aleve, and Excedrin. Brand-name NSAID prescriptions include Celebrex, Naprelan, Anaprox, and Voltaren.
A word of caution: long-term use can lead to gastrointestinal upset and bleeding, and the FDA warns that NSAIDs (other than aspirin) may increase the risk of heart disease and stroke.
Acetaminophen, the active ingredient in Tylenol, is an over-the-counter drug that addresses acute pain like headaches. It’s also found in many combination medicines like those for colds and flus. Acetaminophen doesn’t cause stomach or heart problems like NSAIDs do, but taking more than recommended can lead to liver damage.
Did you know that antidepressants can sometimes treat pain? Tricyclic antidepressants like imipramine (Tofranil), nortriptyline (Pamelor), and amitriptyline (Elavil) have been shown to lessen pain in some people, especially pain caused by damaged nerves.
Two other types of antidepressants — SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) — may help with long-term pain, although more research is needed to confirm this.
4) Anti-epileptic drugs
Anti-epileptic drugs, especially newer ones like gabapentin (Neurontin) and pregabalin (Lyrica), have been used to address chronic nerve pain from conditions like diabetes, shingles, herniated disks, and fibromyalgia. But how well they work is still unclear — some people find them really helpful, while others experience no benefit at all.
Corticosteroids, commonly referred to as “steroids”, can treat both acute and chronic pain. They decrease inflammation, swelling, and pain by suppressing immune cell activity, and are used to treat pain in patients with arthritis, back injuries, nerve pain, and cancer. Steroids commonly used for pain relief include dexamethasone (DexPak), prednisone (Deltasone), and prednisolone (Prelone).
Steroids can cause systemic side effects like weight gain, high blood pressure, and a weakened immune system. Taking low doses short-term and using injections and creams just at the site of pain (instead of taking pills) can help to reduce those side effects.
6) Non-drug treatments
Lastly, but certainly not least, you always have the option of non-drug treatments for pain relief. In fact, organizations as diverse as the American College of Physicians, the U.S. Department of Veterans Affairs, and the Centers for Disease Control and Prevention recommend non-drug treatments as the first course of action for chronic pain. Some examples include:
- Physical therapy
- Cognitive behavioral therapy
- Relaxation therapy
Research is still inconclusive on how effective some of these therapies are, though many patients have reported success. Be sure to consult a healthcare provider as you consider trying them.