Pain medications at a glance

Medication type	How they work	First line option for	Benefits	Risks
NSAIDs	Block COX-1 and COX-2 enzymes involved in pain and inflammation	Mild to moderate pain accompanied by swelling and inflammation Arthritis pain and pain resulting from muscle sprains and strains, back and neck injuries, overuse injuries, and menstrual cramps	When taken as directed, generally safe for short-term use Available without a prescription	May cause nausea, stomach pain, stomach bleeding or ulcers When taken in high doses, can lead to kidney problems, fluid retention and high blood pressure Increased risk of side effects for older adults
Acetaminophen	Thought to block prostaglandin production in the central nervous system	Mild to moderate pain	Available without a prescription	When more than the recommended dose is taken or when taken with alcohol, increased risk of kidney damage and liver failure over time
COX-2 inhibitors	Block COX-2 enzymes	Rheumatoid arthritis, osteoarthritis, menstrual cramps and injury-related pain	As effective as NSAIDs without damaging stomach lining at regular doses	Headache and dizziness When taken in high doses, can lead to stomach bleeding, kidney problems, fluid retention, high blood pressure, heart attack and stroke Increased risk of side effects for older adults
Antidepressants	Interfere with certain chemical processes that cause you to feel pain	Neuropathic pain, chronic headaches, fibromyalgia May be considered for chronic low back pain	Can be in doses much lower than what is currently used to treat depression Side effects generally mild, depending on the type of antidepressant	Drowsiness possible with tricyclic antidepressants Can take several weeks to produce desired effects May worsen depression and cause suicidal thoughts in a small number of people
Anti-seizure medications	Quiet pain signals from damaged nerves	The burning pain of shingles, known as postherpetic neuralgia; diabetic neuropathy; fibromyalgia	Side effects generally mild	May cause dizziness, drowsiness, nausea, reduced coordination and weight changes May worsen depression and cause suicidal thoughts in a small number of people
Opioids	Blocks opioid receptors, which stop the release of chemicals that cause pain Can stop the transmission of pain signals	Acute pain, such as pain that follows surgery or a bone fracture Typically prescribed for a few days or less	Powerful relief during short periods of severe pain	Feeling drowsy, nausea, itchiness, constipation Tolerance, dependence, misuse, addiction and overdose Taking opioids for longer than the prescribed length of time increases the risk of staying on them long term Responsible for the majority of overdose deaths in the U.S.

Mayo Clinic Minute: Avoid opioids for chronic pain

Vivien Williams: 50 million. That's how many people in the U.S. suffer from chronic pain. Many turn to opioid painkillers for relief.

Mike Hooten, M.D. (Anesthesiology, Mayo Clinic): The evidence is not all that clear about the efficacy of those drugs long-term for chronic pain.

Vivien Williams: Mayo Clinic pain management specialist Dr. Mike Hooten says what is clear about these painkillers is the risk associated with taking them.

Mike Hooten, M.D.: The problems of addiction, but a related problem of accidental overdose deaths.

Vivien Williams: Morphine, oxycodone and hydrocodone are commonly prescribed opioids. Dr. Hooten says they are very effective when used short-term for pain, for example, after a surgery. For long-term use …

Mike Hooten, M.D.: There are a small group of studies that may show some benefit in in certain highly select groups of patients.

Vivien Williams: But, for many cases of chronic pain, Dr. Hooten says non-opioid pain relievers combined with other therapies, such as stress management can help people manage pain and maintain a high quality of life. For the Mayo Clinic News Network, I'm Vivien Williams.

Mayo Clinic Minute: When are opioids OK to take?

Vivien Williams: This can be a common scenario: raiding the medicine cabinet for leftover painkillers after a sprained ankle or toothache. There's nothing wrong with popping an occasional opioid, right?

Mike Hooten, M.D. (Anesthesiology, Mayo Clinic): They are dangerous. They could have adverse effects that the individual doesn't even know about.

Vivien Williams: Including addiction or accidental overdose. So, when is it appropriate to take opioids?

Mike Hooten, M.D.: After an operation, opioids are highly effective.

Vivien Williams: Dr. Mike Hooten is a pain management specialist at Mayo Clinic.

Mike Hooten, M.D: After trauma, for example, severe trauma, opioids would be appropriate.

Vivien Williams: Dr. Hooten says opioids are also beneficial during procedures, such as colonoscopies. Problems happen when people take them without a prescription or for too long.

Mike Hooten, M.D.: If they are predisposed to develop addiction, either neurobiologically or from a behavioral perspective, then all of a sudden we are selecting the individuals who may go on to have long-term problems.

Vivien Williams: If you have pain, talk to your health care provider. For the Mayo Clinic News Network, I'm Vivien Williams.