Key takeaways:
- For people living with chronic pain, there are many non-opioid painkillers that are safer and more effective for long-term use.
- Experts recommend non-medication options as the first-choice treatment for pain relief. After that, the next safest options are medications like acetaminophen (Tylenol) or topical NSAIDs (nonsteroidal anti-inflammatory drugs).
- Even if opioids are part of your pain treatment plan, non-medication and non-opioid options can help lower your dosage of stronger painkillers with more serious side effects.
Table of contents
About 50 million adults in the U.S. live with chronic pain (long-term pain that lasts for more than 3 months). And this is a big deal because chronic pain can have a large effect on someone’s physical and mental health. It’s important for people to have strong, non-opioid painkillers that let them more easily carry out their daily activities.
Fortunately, there are several medication options that relieve chronic pain. In general, pain relievers are either opioids or non-opioids. While opioids are effective at relieving short-term pain, they’re not effective long-term options. And they’re also linked to opioid use disorder. This is why the CDC recommends non-medication treatments or non-opioid pain medication as first-choice options.
Let’s review six non-opioid medications for pain relief. This way, you can choose a safe and effective long-term treatment plan that works for you.
1. Acetaminophen
Acetaminophen, the active ingredient in Tylenol, is an over-the-counter (OTC) medication that’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.
It is a great first-choice pain reliever, and it can be used along with other painkillers. Research shows that acetaminophen may relieve a similar amount of pain as opioids. 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 usually 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 heavily.
2. NSAID pills
NSAIDs (nonsteroidal anti-inflammatory drugs) are great for treating mild to moderate pain, such as pain from muscle injury, inflammation (swelling), arthritis, and back issues. NSAIDs also lower fever.
They’re another good first-choice option for pain and can be taken with acetaminophen for additional relief. Similar to acetaminophen, they can help avoid (or lower) the need for opioid painkillers. If needed, combining an NSAID and opioid is an effective way to relieve pain.
NSAIDs are available as the following OTC pills:
NSAIDs are also available as the following prescription-only products:
- Higher-strength naproxen (Anaprox, Naprosyn, Anaprox DS)
- Higher-strength ibuprofen
- Indomethacin (Indocin)
- Diclofenac tablets
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:
NSAIDs can also raise the risk of heart disease and stroke. If you’re over 75 years old, there’s a higher risk for some of these side effects, like ulcers and gut bleeding. So experts do not recommend taking NSAIDs long term. Instead, they recommend other options, like non-medication treatments and some non-NSAID pain relievers.
Quiz: Advil or Tylenol? Test Your Knowledge!
Advil or Tylenol?
Test your knowledge!
Advil (ibuprofen) and Tylenol (acetaminophen) are two pain relievers available without a prescription. But there are several differences between them. Take this quiz to see how much you know about Advil and Tylenol.
3. Celebrex
A newer NSAID, celecoxib (Celebrex), is available by prescription only. Celebrex is a COX-2 inhibitor medication. It works well as a painkiller and an anti-inflammatory medication.
Taking celecoxib with a proton pump inhibitor, like Nexium (esomeprazole), might lower the risk for stomach and gut problems. But celecoxib still has the potential to cause kidney damage and carries a risk for heart disease and stroke that is similar to other NSAIDs.
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 is centered around a joint or in a specific area of the body.
Some examples of topical NSAIDs include:
- Diclofenac gel (Voltaren)
- Diclofenac liquid solution (Pennsaid)
- Diclofenac patch (Flector)
- Diclofenac cream
These are worth a try. They can be as effective as oral (by mouth) NSAIDs, which may lower your need for pain reliever pills. This can help you avoid some of the unwanted side effects of the oral NSAIDs listed above.
5. Anti-epileptic drugs
Anti-epileptic drugs, especially ones like gabapentin (Neurontin) and pregabalin (Lyrica), can help treat persistent nerve pain from the following conditions:
- Diabetes
- Shingles
- Spinal cord injury
- Fibromyalgia
In general, these medications work by calming down neurons (nerve cells).
Gabapentin and pregabalin can have some similar side effects to opioids, like sleepiness and drowsiness.
6. Antidepressants
Some antidepressants can also work as effective painkillers, especially for pain caused by damaged nerves. Options include:
- Older tricyclic antidepressants, like amitriptyline
- SNRIs (serotonin and norepinephrine reuptake inhibitors), like duloxetine (Cymbalta)
These antidepressants can also relieve symptoms of depression, which can often occur along with chronic pain.
What are some non-medication options for pain relief?
Medications can work well to treat pain, but there are many ways to treat pain that do not involve medications.
Some examples include:
- Exercise
- Physical therapy
- Massage
- Cognitive behavioral therapy
- Acupuncture
- Biofeedback
- Relaxation therapy
- Virtual reality (VR) devices
Organizations as diverse as the American College of Physicians, the U.S. Department of Veterans Affairs, and the CDC recommend non-medication treatments as go-to options for persistent pain.
Tips for non-opioid pain management
Living with pain is difficult. But knowing how to self-manage your pain can help lessen how severe your pain is and improve your quality of life. Here are five general tips to help you self-manage your pain:
- Try to reframe your goals for pain relief. 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 still gives you an effect you’re happy with.
- Always try non-medication strategies and non-NSAID pain relievers first. Continue using them even if you also have to take opioids.
- If you take multiple pain medications, make the safest one your go-to painkiller. This will help you take less of the medications with more risks.
- Remember that NSAIDs and opioids are not meant for long-term use. If you have been needing these medications for more than a couple months, it’s a good time to talk to your healthcare provider for safer and more effective options.
When might a doctor recommend an opioid painkiller?
There still may be times when your doctor 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 doctor or healthcare provider or pain specialist if:
- Your pain negatively affects your quality of life.
- Your pain gets in the way of important life activities. Just a few examples are going to school or work, household chores, caring for children or pets, and daily bathing and 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 doctor. This can help make sure your plan is right for you and that 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
The bottom line
If you’re living with chronic pain, there are many safe, non-opioid options to help relieve your pain. You may need to try different approaches, but don’t give up hope. Start with some non-medication treatments as your foundation. If you need additional medication on top of that, work with your provider to find the safest and most effective option for you. Even if you still need stronger pain medications from time to time, these strategies can still go a long way in helping you live with less pain. And, in turn, this will lessen your need for riskier medications.