Prescription Pain Meds: Here’s What You Need to Know

Published by Ginger Hultin, MS RDN CSO

September marks Pain Awareness Month, a time to shed light on the challenges of people living with pain and the various ways to manage it. While nutrition, lifestyle changes, and natural remedies play vital roles in pain management by reducing inflammation, prescription pain medications are sometimes also a necessary component for those dealing with chronic or severe pain. If you’re considering or currently using these medications, it’s essential to understand how they work, their benefits, and potential side effects so that you can have meaningful conversations with your medical team about how your pain is managed.

Overview

Prescription pain medications, also known as “analgesics,” are drugs prescribed by healthcare professionals to relieve moderate to severe pain. They work by altering the way the brain and nervous system respond to pain signals, effectively reducing the sensation of pain for a period of time.

There are several types of prescription pain medications, each working in different ways:

Antidepressants and Anticonvulsants: Though originally designed to treat depression and seizures, certain antidepressants and anticonvulsants can also help manage chronic pain, especially nerve pain, by affecting neurotransmitters in the brain. Serotonin and norepinephrine reupdate inhibitors (SNRIs) such as Effexor XR, Cymbalta, Savella, and Pristiq fall under the antidepressant category, while gabapentin, carbamazepine, and phenytoin are pain-relieving anticonvulsants.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications, such as ibuprofen and naproxen, reduce pain by decreasing inflammation – many are over the counter (OTC). They are often used for conditions like arthritis, muscle pain, and menstrual cramps. Some NSAIDs are prescribed, including Celebrex, Voltaren, Nalfon, Indocin, and Toradol. Your doctor can discuss the pros and cons of a prescription vs OTC NSAID for your unique pain challenges.
Opioids: These are powerful pain relievers used for severe pain, often after surgery or injury, or for chronic conditions like cancer. Common opioids include oxycodone, hydrocodone, and morphine. They work by binding to opioid receptors in the brain, blocking pain signals. These medications can cause drowsiness, confusion, nausea, constipation, feelings of euphoria, and slowed breathing. Unfortunately, long-term use of these medications can lead to developing a tolerance, meaning that people need higher and more frequent doses to manage their pain. Drug dependence and addiction can also occur with repeated use, and overdoses are also a real risk with this class of medication. The Substance Abuse and Mental Health Services Administration has a free, confidential, 24/7, 365-day-a-year treatment referral helpline that anyone can use: 1-800-622-HELP (4357).

How Pain Medications Work

Prescription pain medications target specific pathways in the body to reduce pain. Opioids, for example, bind to opioid receptors in the brain, spinal cord, and other areas, dampening the body’s pain response. NSAIDs block the production of prostaglandins, inflammatory chemicals in the body that promote pain and fever. Anti-depressants and anticonvulsants work on parts of the brain that manage nerves and the sensation of pain in the body.

All of these medications can be effective, especially in cases where pain is unmanageable by other means. However, they must be used with caution due to the potential for side effects and dependency. It’s critical that you have an ongoing relationship with your doctor about managing pain. There are physicians who specialize in pain management and so if pain is a challenge for you, seeking someone who has the expertise to help can be key.

Considerations When Using Prescription Pain Medications

While prescription pain medications can be life-changing for many, they come with important considerations:

Dependency: Opioids, in particular, carry a high risk of dependency and addiction. It’s crucial to follow your healthcare provider’s instructions closely, use the lowest effective dose, and discuss any concerns with your provider if you’re at risk.
Interactions with Other Medications: Prescription pain medications can interact with other drugs, including OTC medications and supplements. Always inform your doctor and pharmacist of all substances (including supplements!) you are taking to avoid harmful interactions.
Side Effects: Common side effects of these medications can be life-impacting. From drowsiness, constipation, nausea, dizziness, stomach upset, ulcers, liver damage, and even increased risk of heart attack or stroke if used long-term.

Prescription pain medications can be a crucial tool in managing pain, but they are not without risks. By understanding how these medications work and being aware of potential side effects, you can make informed decisions about your pain management strategy. Always consult with your healthcare provider to ensure that your pain management plan is safe and effective and consider integrating complementary therapies to enhance your overall well-being. In addition to medications, consider incorporating other pain management strategies, such as physical therapy, acupuncture, mindfulness, and anti-inflammatory dietary changes. A comprehensive approach can often reduce the need for higher doses of medication.

References
National Institute on Drug Abuse. What are prescription opioids? https://nida.nih.gov/publications/drugfacts/prescription-opioids. Published June 2021.

Substance Abuse and Mental Health Services Administration. SAMHSA’s National Helpline. https://www.samhsa.gov/find-help/national-helpline. Updated June 2023.

Amaechi O, Human MM, Featherstone K. Pharmacologic therapy for acute pain. American family physician. 2021 Jul;104(1):63-72.

Ghlichloo I, Gerriets V. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547742/

Ferreira GE, Abdel-Shaheed C, Underwood M, et al. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. bmj. 2023 Feb 1;380.

Ginger Hultin, MS RDN CSO

Ginger Hultin MS RDN CSO is a Seattle-based Registered Dietitian Nutritionist and long time contributor to nutrition content on Foodtrients®. She is the owner of the concierge, virtual nutrition practice Ginger Hultin Nutrition where she helps clients with complex health conditions through an integrative approach. She specializes in anti-inflammatory diets for integrative oncology nutrition, people with gastrointestinal disease, and autoimmune issues. Her 10-year partnership with Foodtrients® has focused on evidence-based anti-aging nutrition, healthy recipes, and "top foods" lists in many categories from blood sugar control to healing your gut. Ginger serves as adjunct clinical faculty at the Bastyr Center for Natural Health in Seattle. She is the director of communications at the Washington State Academy of Nutrition and Dietetics, a past Spokesperson for the Academy of Nutrition and Dietetics, and past-chair of the Vegetarian Nutrition Dietetic Practice Group. She has authored two nutrition books: Anti-Inflammatory Diet Meal Prep and the How to Eat to Beat Disease Cookbook. Ginger is a graduate of the University of Washington and Bastyr University and is currently pursuing her doctorate of clinical nutrition at the University of North Florida.