A Complete Guide to Non-Narcotic Pain Medication: NSAIDs, Non-NSAIDs, and Other Options

Whether you have a headache or a broken arm, there are plenty of reasons to take pain medication. Many people are interested in avoiding opioid pain medications (also called narcotics) for several reasons. They’re highly addictive, can make you feel dizzy and sleepy, and cause difficult-to-treat constipation.

Fortunately, there are several other options for pain relief. Non-narcotic pain medications are effective and safe for most people. In fact, experts recommend non-medication treatments and non-opioid pain medication before trying opioids.

Let’s review seven non-narcotic pain medications. This way, you know your options when it comes to pain relief.

1. Acetaminophen

Acetaminophen, the active ingredient in Tylenol, is an over-the-counter (OTC) pain medication. It’s good for relieving headaches, back pain, and arthritis pain. It’s also in many combination cold and flu medications, and it can help lower a fever.

Studies consistently find that acetaminophen provides similar pain relief to opioids. This is true in both intravenous (IV) and oral (by mouth) forms. And, for people who still need to take opioids for pain, combining acetaminophen with an opioid can help them lower their opioid dosage.

You don’t need a prescription for acetaminophen. And if you stick to the recommended dosages, it’s a safe medication. But like all medications, it does have some side effects. For example, acetaminophen can lead to liver damage if you take too much. For this reason, you should avoid it if you have liver disease or drink alcohol.

2. NSAID pills

Nonsteroidal anti-inflammatory drugs (NSAIDs) are great for treating mild-to-moderate pain, such as pain from: 

• Muscle injury

• Inflammation (swelling)

• Arthritis

• Back issues

NSAIDs also lower fever. NSAIDs work by blocking an enzyme (protein) called cyclooxygenase (COX), which lowers prostaglandin levels in the body. Prostaglandins are substances that contribute to pain and inflammation.

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They’re another good first-choice option for pain. And they can be taken with acetaminophen for additional relief. Similar to acetaminophen, NSAIDs can help avoid (or lower) the need for opioid painkillers.

NSAIDs are available as the following OTC pills:

• Ibuprofen (Advil, Motrin)

• Naproxen (Aleve)

• Aspirin

NSAIDs are also available as the following prescription-only products:

• Higher-strength naproxen (Anaprox, Naprosyn, Anaprox DS)

• Higher-strength ibuprofen

• Indomethacin (Indocin)

• Diclofenac tablets

• Meloxicam

People respond differently to these options. So, if you don’t get the results you want with one, it’s worth trying a different one.

Some of the potential side effects of NSAIDs are:

• Heartburn

• Stomach ulcers

• Stomach bleeding

• Kidney damage

• Increased risk of heart disease and stroke

Because of these side effects, experts don’t recommend taking NSAIDs long term.

Take our quiz: Advil or Tylenol?

3. Celecoxib

Celecoxib (Celebrex, Vyscoxa, Elyxyb) is an NSAID that’s available by prescription only. It works well as a painkiller and an anti-inflammatory medication.

The other NSAIDs are nonselective COX-inhibitors. Celecoxib, though, is a COX-2 inhibitor medication. This makes it less likely to cause stomach problems, but it’s still a risk. Studies suggest taking NSAIDs like celecoxib with a proton pump inhibitor, like Nexium (esomeprazole), might lower the risk for stomach problems.

Celecoxib has other side effects similar to other NSAIDs. They include the potential to cause kidney damage and increased cardiovascular risk.

4. NSAID gels, liquids, patches, and creams

NSAIDs are also available as topical products, like anti-inflammatory creams. These can help with some types of pain, particularly when the pain involves a joint or specific area of the body.

Some examples of topical NSAIDs include:

• Diclofenac gel (Voltaren)

• Diclofenac liquid solution (Pennsaid)

• Diclofenac patch (Flector)

• Diclofenac cream

Topical NSAIDs can be as effective as oral NSAIDs, which may lower your need for pain reliever pills. This can lessen the risk of unwanted NSAID side effects, like those listed above.

5. Anti-seizure medications

Anti-seizure medications, such as gabapentin (Neurontin) and pregabalin (Lyrica), are often recommended for nerve pain. They work by calming down neurons (nerve cells). So they can help treat persistent nerve pain from the following conditions:

• Diabetic neuropathy

• Shingles

• Spinal cord injury

• Fibromyalgia

Gabapentin and pregabalin can have some similar side effects to opioids, like sleepiness and drowsiness. Pregabalin is a controlled substance, which means there’s a chance for misuse. Gabapentin is considered a controlled substance in some states.

6. Antidepressants

Some antidepressant medications can treat some types of pain. They can help with pain caused by damaged nerves. A common one is duloxetine (Cymbalta, Drizalma Sprinkle), which is a serotonin and norepinephrine reuptake inhibitor (SNRI). Duloxetine can also help manage fibromyalgia pain and long-standing musculoskeletal pain.

Another option is tricyclic antidepressants, like amitriptyline. But note that amitriptyline for nerve pain would be considered an off-label use.

7. Muscle relaxers

Muscle relaxers are sometimes prescribed for musculoskeletal pain, such as an acute back strain. Examples include:

• Cyclobenzaprine (Amrix, Tonmya)

• Methocarbamol (Robaxin)

• Metaxalone

These medications can make you drowsy and cause medication interactions. Plus, available evidence shows that muscle relaxers don’t work for back and neck pain for more than a week or two. If you do take a muscle relaxer for pain relief, it’s best to avoid using it long term.

What are some natural options for pain relief?

Medications can work well to treat pain, but there are many ways to treat pain that don’t involve medications. In fact, many experts, including the American College of Physicians and the American Society of Anesthesiologists, recommend non-medication treatments as go-to options for pain relief.

Some examples include:

• Exercise

• Physical therapy

• Massage

• Cognitive behavioral therapy (CBT)

• Acupuncture

• Biofeedback

• Relaxation therapy

Tips for non-opioid pain management

Pain is a part of life. But it can be inconvenient, frustrating, and difficult. Knowing how to self-manage your pain can help lessen how severe your pain is and improve your quality of life. Here are some general tips to help self-manage your pain:

• Try to reframe your goals for pain relief. In other words, think about what you want to be able to do, rather than how you want to feel.

• Take the lowest dose of pain medication that allows you to get those things done.

• Always try non-medication strategies and non-opioid pain relievers first. Often a combination works best.

• Remember that many pain medications are not meant for long-term use. 

If you’ve been taking pain medications for more than a couple weeks, it’s a good time to talk to a healthcare professional. They can help you find safer and more effective options. Depending on the cause of your pain, there may be other treatment options.

When might a healthcare professional recommend an opioid painkiller?

There still may be times when a healthcare professional may recommend taking opioids. This is usually for a short period of time, at the lowest dose possible, and in addition to non-opioid treatments.

Talk with your primary care provider or pain specialist in these cases:

• Your pain negatively affects your quality of life.

• Your pain gets in the way of important life activities. Just a few examples are school, work, household chores, caring for children or pets, and daily hygiene.

• Your pain prevents you from doing activities that are important or enjoyable to you.

And before you start taking an opioid, it helps to outline a treatment plan with your healthcare team. This can help make sure you minimize use of opioids as much as possible. This includes:

• Your pain management goals and your expectations for your pain treatment plan

• Your expected timeline to achieve those goals

• Whether the benefits of an opioid medication outweigh the risks

• When you plan to reevaluate the progress of your pain control and treatment plan

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Written by:

Ross Phan, PharmD, BCACP, BCGP, BCPS

Ross Phan is a board-certified clinical pharmacist. She has roughly two decades of healthcare experience — with most of her experience being pharmacy related.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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