Non-narcotic medications vary in effectiveness related to the severity and type of pain they are treating. They are generally considered to be safer for treating pain on a long-term basis than opioid medications.
Why Choose Non-Narcotic Pain Medications?
Pain can be a debilitating condition that can be either acute and short-term or chronic. Chronic pain is described as pain lasting for three months or longer.
Chronic pain is often the result of a health condition. Acute pain may be due to injury or a medical procedure, such as a surgery. Pain needs to be managed to improve quality of life and help with a person’s ability to focus.
While opioids can provide short-term relief for pain, they are not generally considered the first-line therapy for chronic pain outside of cancer treatment, palliative care, and end-of-life care. Opioids are narcotic medications that are tightly controlled and part of a public health crisis.
Opioids are extremely addictive and have a high potential for fatal overdose. In 2020, nearly 3 million adults in the United States had an opioid use disorder in the past year.
Ibuprofen (Advil, Motrin)
Ibuprofen is an NSAID medication that is available in both over-the-counter and prescription forms. Ibuprofen works to reduce inflammation and fever.
It is available as a tablet, suspension, chewable tablet, and concentrated liquid (drops) to be taken by mouth every four to six hours as needed for pain. Ibuprofen is also available as a combination medication, such as in combination cold medications.
Ibuprofen can help to manage the following types of pain:
- Rheumatoid arthritis
- Menstrual pain
- Muscle aches
Ibuprofen can be effectively used to control mild to moderate pain without risk for substance dependence or addiction.
Acetaminophen is a pain reliever and fever reducer contained in hundreds of OTC and prescription medications. It can be used to treat mild to moderate pain that is both acute and chronic.
Acetaminophen is both an analgesic (pain reliever) and antipyretic (fever-reducing) medication that can be used to treat a variety of types of pain by changing the way the body perceives pain sensations.
Acetaminophen is available in a variety of formulations, including these:
- Chewable tablet
- Extended-release tablet
- Oral disintegrating tablet
Acetaminophen products should be taken as directed and in controlled dosages to avoid possible liver damage. Acetaminophen is not habit-forming.
A salicylate medication, aspirin is available as an extended-release prescription tablet to relieve the symptoms of osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and additional rheumatologic conditions.
Aspirin stops the body from producing substances that cause pain, swelling, fever, and blood clots. Non-prescription aspirin is used to manage mild to moderate pain as well as to prevent future heart attacks and ischemic strokes.
Aspirin is available as a tablet, delayed-release tablet, chewable tablet, powder, and gum. It should be taken exactly as directed. Aspirin is also available as a combination medication with other pain relievers, antacids, and cold medications.
Aspirin can help to lower the rate of death in people who have had heart attacks and prevent blood clots. It is also nonaddictive.
Available as both a prescription and non-prescription medication, naproxen is another NSAID medication that blocks the body’s production of a naturally occurring substance that causes pain, inflammation, and fever.
Prescription naproxen is used to help manage pain, swelling, stiffness, and tenderness related to various forms of arthritis. It is prescribed in tablet form, as an extended-release tablet, delayed-release tablet, and suspension. It is also prescribed to relieve pain related to the following:
- Gouty arthritis
- Menstrual pain
- Additional types of pain
OTC naproxen is taken to reduce fever or relieve mild pain. Nonprescription naproxen is taken as a tablet, capsule, or gel capsule by mouth.
Naproxen is generally taken once to twice per day. Long-term use can cause stomach ulcers, so talk to your doctor about this risk.
Naproxen should be taken exactly as directed and is not considered habit-forming.
Corticosteroids are medications with anti-inflammatory properties, which can help to relieve pain related to swelling. Anti-inflammatory corticosteroids are classified as glucocorticoids. They include the following:
- Hydrocortisone (Cortisol)
- Triamcinolone (Kenalog, Aristocort)
- Methylprednisolone (Medrol, Depo-Medrol)
- Dexamethasone (Decadron)
- Betamethasone (Celestone)
Corticosteroids are typically injected or taken orally when prescribed for pain. They can be used via injection for painful spinal conditions or joint pain, to manage pain and swelling related to rheumatoid arthritis, for muscle trigger points, or as nerve blocks for neurogenic pain. Corticosteroids are often combined with an anesthetic when injected. Injecting corticosteroids requires great skill, and there is some debate around its effectiveness.
The efficacy of oral corticosteroids is debated.
An anticonvulsant medication designed to control epileptic seizures, gabapentin is also prescribed to treat neuropathic pain, or pain related to nerve damage. Gabapentin is prescribed primarily for chronic postherpetic pain and pain related to diabetic neuropathy. It is proven to be moderately to significantly effective.
Gabapentin works by calming down some of the nerve responses in the brain to relieve pain. It is taken orally as a tablet, extended-release tablet, or oral solution.
While antidepressant medications are typically used as mood stabilizers, they can also be at least moderately effective in treating certain types of chronic pain.
Some of the most common antidepressant medications used on chronic neuropathic pain have been tricyclic antidepressants, or TCAs. Both desipramine and amitriptyline can effectively treat the shooting pain of diabetic neuropathy in lower doses than what is needed to treat depression.
TCAs have some significant side effects, however. They can cause blurry vision, dry mouth, and sedation. They do not perform as well for older adults.
SNRIs (selective norepinephrine reuptake inhibitors) are typically better tolerated and more widely used today. Duloxetine (known by the brand name Cymbalta) is FDA approved to treat chronic pain.
Duloxetine has been clinically proven to reduce the pain response in the body related to chronic pain, helping to relieve symptoms and improve physical mobility.
Antidepressants can take some time to relieve pain symptoms, but they can be effective in managing some forms of chronic pain.
Other Pain Management Methods (Alternatives to Opioids)
Opioid pain medications have a host of negative side effects from the potential for fatal overdose to drug dependence, withdrawal symptoms when you stop them, and addiction. Because of these issues, medical professionals are consistently seeking out alternatives to opioids. This includes both pharmacological and non-pharmacological approaches.
Non-narcotic medications include the following:
- NSAIDs, aspirin, and acetaminophen
Localized pain medications are mildly to moderately effective, including lidocaine patches.
For certain conditions, surgical interventions can help to correct issues that are causing the pain.
Complementary methods can also be used for some relief of pain, including the following:
- Chiropractic care
- Guided imagery
- Heat therapy
- Music therapy
- Cognitive behavioral therapy (CBT)
- Spinal manipulation
- Group support activities
- Exercise therapy
- Pain education
New Developments in Pain Management
Researchers are continually looking for new non-opioid methods for treating pain. There is a range of medications being investigated for their effectiveness in treating pain.
As more information is discovered on how the brain and body work and what causes pain, researchers are able to look more closely into the types of things that might be able to more effectively relieve pain with fewer side effects. Generally speaking, it is understood that a combination of medications and complementary methods is the best way to manage chronic pain symptoms.
Are Non-Narcotic Pain Meds Effective?
Non-narcotic pain medications can be effective for managing some types of pain. Some types of medications are more effective than others, and the type of pain being treated matters too.
Mild and moderate acute pain, such as headaches or sore muscles or joints, can often be managed with NSAIDs and OTC medications. Chronic pain often requires more specialized treatment methods.
Studies have shown the following results related to chronic pain:
- Moderate improvement in pain and function with certain antidepressants for neuropathic pain on a short-term basis
- Small improvement in pain and function using specific anticonvulsant medications on a short-term basis
- Small improvement in pain related to osteoarthritis and inflammatory arthritis with NSAIDs for short-term use
- Some benefit of using SNRIs for treating low back pain and fibromyalgia pain in the intermediate term
- Limited evidence about any long-term treatment for chronic pain
In general, pain relievers are best used as part of a comprehensive treatment plan for managing pain that will include additional methods beyond just pharmacological methods.
Benefits of Non-Narcotics Over Opioids
Opioids are typically considered the strongest form of pain relievers. However, they have many dangerous side effects and are therefore not recommended to use on a long-term basis or as a first-line therapy for pain when possible.
Non-narcotic drugs can still have side effects of use. However, they are not generally as habit-forming or potentially addictive as opioid medications can be.
Opioid drugs make changes to the way your brain perceives pain, binding to opioid receptors in the brain to block the pain response. Opioids are also mind-altering, changing the chemical pathways in the brain related to reward processing and feelings of pleasure.
This can cause physical dependence, leading to serious emotional and physical withdrawal symptoms when they wear off, which can cause a person to keep taking them to keep feeling the effects. You can also build a tolerance to opioid drugs, meaning that you will need to take more and more to keep feeling their effects.
Non-narcotic medications do not carry the same risk for overdose and addiction that opioid drugs do. They will not typically alter brain chemistry and neurological pathways in the same way.
Non-narcotic medications can be just as beneficial on specific types of pain, especially mild to moderate pain. They carry much fewer risks, so they are generally preferred to opioids.
When Are Opioids Necessary?
Opioid drugs can be necessary when other methods of relieving pain are not working. Opioid medications are optimal for short-term management of acute pain under the supervision and direction of a trained medical professional. Opioids should most commonly be prescribed after other methods are attempted first.
Opioid medications are regularly prescribed for the following types of pain:
- Postsurgical or acute injury pain
- Moderate to severe pain
- Cancer pain
- Palliative care
- End-of-life care
Prescription opioids should only be prescribed when absolutely necessary, in the lowest possible dose, and for the shortest amount of time as possible. Patients should be educated on the risks of opioid medications, and they should be prescribed as only one part of a more complete treatment plan.
There are many additional options when it comes to pain management. Because of the availability of other options, opioid medications should be used sparingly and only under direction and supervision of a trained medical professional.
- Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. (October 2021). Substance Abuse and Mental Health Services Administration.
- Nonopioid Treatments for Chronic Pain. Centers for Disease Control and Prevention.
- Ibuprofen. (January 2022). U.S. National Library of Medicine.
- Acetaminophen. (June 2022). U.S. Food and Drug Administration.
- Aspirin. (May 2021). U.S. National Library of Medicine.
- Naproxen. (March 2022). U.S. National Library of Medicine.
- Corticosteroid Use in Pain Management. (January 2012). Practical Pain Management.
- Gabapentin for Chronic Neuropathic Pain in Adults. (June 2017). Cochrane Library.
- Tricyclic Antidepressants in Neuropathic Pain: The Good, the Bad, and the Potentially Ugly. (January 2016). Pharmacy Times.
- Efficacy of Duloxetine in Patients with Chronic Pain Conditions. (November 2011). Current Drug Therapy.
- Nonnarcotic Methods of Pain Management. (June 2019). New England Journal of Medicine.
- Nonopioid Pharmacological Treatments for Chronic Pain. (June 2022). Agency for Healthcare Research and Quality.