How to Choose the Correct Pain Medication for Your Pain

Here’s a detailed overview of common pain medications, categorized by type.

This includes how they work, what they’re used for, and potential risks. This information is helpful for understanding both over-the-counter (OTC) and prescription options

1. Acetaminophen (Paracetamol, brand name: Tylenol)

Acetaminophen is usually recommended first for mild to moderate pain. It might be taken for pain due to a skin injury, headache, or conditions that affect the muscles and bones. Acetaminophen is often prescribed to help manage osteoarthritis and back pain. It also may be combined with opioids to reduce the amount of opioid needed.

• Generic (brand) names. Acetaminophen (Tylenol, others).
• How it works. Acetaminophen is thought to block the production of prostaglandins in the central nervous system. Prostaglandins are hormonelike substances that are involved in pain and inflammation. Unlike NSAIDs, acetaminophen doesn’t target inflammation at the site of injury — only pain.
• Benefits and risks. Acetaminophen is generally considered safer than other pain relievers. It doesn’t cause side effects such as stomach pain and bleeding. However, taking more than the recommended dose or taking acetaminophen with alcohol increases the risk of kidney damage and liver failure over time.
• Bottom line. Acetaminophen is generally a safe option to try first for many types of pain, including chronic pain. Ask your healthcare professional for guidance about safely taking acetaminophen if you take other medications. Acetaminophen is not as effective as NSAIDs for the treatment of knee and hip pain related to osteoarthritis.
• Used for: Headaches, fever, mild to moderate pain (muscle aches, arthritis, colds).
• Pros: Gentle on the stomach; widely available.
• Risks: Liver damage at high doses or when combined with alcohol or other medications that affect the liver.

2. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)

Includes ibuprofen (Advil, Motrin), naproxen (Aleve), aspirin, and diclofenac.NSAIDs are most effective for mild to moderate pain that occurs with swelling, known as inflammation. These medications are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps.

• Generic (brand) names. Ibuprofen (Advil, Motrin IB, others); naproxen sodium (Aleve); others.
• How they work. NSAIDs work by stopping certain enzymes in your body from being released due to tissue damage. These enzymes are called cyclooxygenase (COX). NSAIDs block different types of COX, including COX-1 and COX-2. As a result, NSAIDs help reduce pain and inflammation that result from an injury.
• Benefits and risks. When taken as directed, NSAIDs are generally safe. But if you take more than the recommended dosage, NSAIDs may cause nausea, stomach pain, stomach bleeding or ulcers. Sometimes this can happen even when you take the recommended dosage.
• Bottom line. If you regularly take NSAIDs, talk to your health care provider. Your healthcare team can monitor you for possible side effects. NSAIDs also have a ceiling effect — a limit as to how much pain they can control. Taking more than the recommended dose may not relieve the pain and may increase the risk of serious side effects.
• Used for: Arthritis, menstrual cramps, muscle pain, back pain, inflammation, headaches.
• Pros: Effective for inflammatory pain; available OTC and prescription.
• Risks:
  • Stomach ulcers, bleeding
  • Kidney damage with long-term use
  • Increased cardiovascular risk (especially with long-term use of high-dose diclofenac or COX-2 inhibitors like celecoxib)

3. Opioids

Opioid medications are synthetic cousins of opium and the drugs derived from opium such as heroin and morphine. These medications are typically prescribed for pain that’s new, known as acute pain. Acute pain can stem from an injury, such as surgery or a broken bone.

Opioids currently cause the most overdose deaths in the United States — and that rate is still rising. Because the risks are so great, opioids are used at the lowest dose possible, usually for just a few days.

• Generic (brand) names. Hydrocodone (Hysingla ER); hydrocodone-acetaminophen; fentanyl; oxycodone (OxyContin, Roxicodone, others); oxycodone-acetaminophen (Percocet, Oxycet); others.
• How they work. Opioids, like real opium, mimic the natural pain-relieving chemicals produced by the brain. These chemicals are called endorphins. The medications turn down the volume on the pain signals your nervous system sends through your body. They also muffle other nerve cell functions, such as breathing, heart rate and level of alertness.
• Benefits and risks. Research shows that over time your body adapts to these medications and they bring less and less pain relief. This is known as tolerance. It means that you need more of the medication to achieve the same degree of pain relief. Long-term use of opioids may lead to dependence on the medications and, eventually, addiction.

  The longer you use opioids, the greater the risk of becoming addicted. But even using opioids to manage pain for more than a few days increases your risk. Researchers have found that the odds of being on opioids a year after starting a short course increases after only five days on the medication.

• Bottom line. Opioids are a last resort for chronic pain management. They may be the right choice for long-term pain related to cancer and its treatments. Rarely, opioids may be used for noncancer pain that hasn’t responded to any other medications. Because the risks are serious, you’ll need careful and frequent follow-ups with your healthcare professional if you use opioids long term.

While there isn’t a cure for chronic pain, many effective pain medications are available to help reduce pain. As you try different medications, work with your healthcare professional to find the simplest long-term solution possible. Keep your medication risks to a minimum to help you enjoy many good days for many years to come.

4. Antidepressants (used for pain)

Includes amitriptyline, duloxetine, nortriptyline, and venlafaxine.

• How they work: Modulate pain signals by increasing serotonin and norepinephrine in the central nervous system.
• Used for: Neuropathic pain, fibromyalgia, migraine prevention, diabetic nerve pain.
• Pros: Can help with both mood and pain.
• Risks: Dry mouth, weight gain, dizziness, fatigue, and interaction with other serotonin-active drugs (risk of serotonin syndrome).

5. Anticonvulsants (used for pain)

Includes gabapentin and pregabalin (Lyrica).

• How they work: Stabilize nerve activity and reduce pain signal transmission in the nervous system.
• Used for: Nerve pain, postherpetic neuralgia, fibromyalgia, diabetic neuropathy.
• Pros: Useful for chronic nerve pain; low addiction risk.
• Risks: Sedation, dizziness, weight gain, swelling, risk of misuse in some cases.

6. Muscle Relaxants

Examples: cyclobenzaprine, methocarbamol, baclofen, tizanidine

• How they work: Act on the central nervous system to reduce muscle spasms.
• Used for: Back pain, muscle injuries, tension headaches.
• Pros: Relieve muscle-related pain.
• Risks: Sedation, dizziness, dry mouth, dependence (especially with long-term use).

7. Topical Analgesics

Includes capsaicin, lidocaine patches, diclofenac gel.

• How they work: Act locally to block pain signals or reduce inflammation.
• Used for: Joint pain, nerve pain, localized muscle pain.
• Pros: Fewer systemic side effects.
• Risks: Skin irritation, burning (capsaicin), or numbness (lidocaine).

8. Cannabinoids

Includes CBD, THC (in regions where legal).

• How they work: Act on the endocannabinoid system, which plays a role in pain perception, inflammation, and mood.
• Used for: Chronic pain, neuropathic pain, multiple sclerosis-related spasticity.
• Pros: May benefit patients who haven’t responded to other treatments.
• Risks: Drowsiness, dizziness, legal restrictions, THC can cause psychoactive effects or dependency.

Choosing a Pain Medication

• For mild pain: Acetaminophen or NSAIDs
• For inflammation: NSAIDs, turmeric (herbal option)
• For nerve pain: Anticonvulsants, antidepressants, topical lidocaine, or St. John’s Wort
• For chronic pain: Often requires a multi-modal approach, combining medications with physical therapy, psychological support, and lifestyle changes
• For severe pain: Opioids may be used cautiously for short periods

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.