You've taken ibuprofen every morning for months. It takes the edge off the pain. But now you're wondering what it's doing to your stomach. You may also wonder if there's something better.
The best painkiller for long-term chronic pain depends on the kind of pain you have. Joint pain and nerve pain often call for different medicines. Safety matters just as much, because a pill that's fine for a week may not be fine for years.
In this guide, we explain the main types of pain medicine and what each one is for. We cover long-term side effects and the signs that mean you should call your provider. We also clear up a common worry: the difference between opioid dependence and addiction. Then we walk through options that may help when pills aren't enough.
Use this guide to build better questions for your provider. It's not a reason to change your medicine on your own.
Which Painkiller Works Best for Chronic Pain?
There is no single best painkiller for long-term chronic pain. The right choice depends on your type of pain and your health history.
Joint and muscle pain. Acetaminophen or NSAIDs, like ibuprofen or naproxen, are often tried first. Long-term use needs a provider's watch because of liver, stomach, kidney, and heart risks.
Nerve pain. Certain antidepressants and anti-seizure medicines are often used in place of standard painkillers.
Pain in one spot. Creams or patches, such as lidocaine or diclofenac gel, are applied right where it hurts.
Opioids. CDC guidance says non-opioid options are preferred for long-term pain.
If medicine isn't enough, treatments like nerve blocks or injections may help.
Why the Right Painkiller Depends on You
Chronic pain is pain that lasts more than three months. At that point, you're not choosing a pill for a few bad days. You're choosing something you may take for a long time.
Different kinds of pain respond to different medicines. Pain from a worn knee joint isn't the same as burning nerve pain in your feet. Headaches and mixed pain follow their own rules too.
Your body also shapes what's safe for you. A provider will look at:
- Your age
- How well your liver and kidneys work
- Other medicines you take
- Any history of stomach ulcers or bleeding
What works short term isn't always safe long term. A pill you took for a sprain may strain your stomach or kidneys after months of daily use.
That's why a pain evaluation at our clinic starts with your history, symptoms, and goals. Knowing what kind of pain you have helps narrow down which options fit you.
The Main Types of Long-Term Pain Medicine
Most long-term pain medicines fall into four groups. Each group works in a different way and fits a different kind of pain.
Over-the-counter pain relievers
Often used for: Joint, muscle, and arthritis pain
Examples: Acetaminophen; NSAIDs such as ibuprofen and naproxen
Nerve pain medicines
Often used for: Burning, tingling, or shooting nerve pain
Examples: Duloxetine (an SNRI); gabapentin and pregabalin
Topicals
Often used for: Pain in one joint or one area
Examples: Lidocaine patches, capsaicin, diclofenac gel
Opioids
Often used for: Severe pain when other options haven't helped
Examples: Oxycodone, hydrocodone, morphine
Nerve pain medicines aren't standard painkillers. Some were first made for depression or seizures. They change how your nerves send pain signals.
Opioids sit at the bottom of the list for a reason.The CDC's 2022 guideline says non-opioid options are preferred for chronic pain. When opioids are used, they need close follow-up.
Never start or stop a prescription on your own. Talk with the provider who prescribes your medicine first.
Side Effects to Watch for with Long-Term Use
Every pain medicine has trade-offs. A risk that's small for a few days can grow with months of daily use. Use this table to check what you're taking now.
NSAIDs (ibuprofen, naproxen)
Common long-term risks: Stomach ulcers and bleeding, kidney damage, higher risk of heart attack and stroke
Call your provider if: You have black or bloody stools, stomach pain, or swelling in your legs or ankles
Acetaminophen
Common long-term risks: Liver damage if you take more than the label allows
Call your provider if: Your skin or eyes turn yellow, or your urine turns dark
Nerve pain medicines
Common long-term risks: Drowsiness, dizziness, weight gain
Call your provider if: You feel unsteady or notice changes in your mood
Opioids
Common long-term risks: Constipation, tolerance, dependence, overdose
Call your provider if: You need more to get the same relief
Acetaminophen can hide in other products. Many cold and cough medicines contain it, along with some prescription pain pills. Check every label, and look for "APAP," which is a short name for acetaminophen.
Some signs can't wait for a callback. Call 911 for chest pain, trouble breathing, weakness on one side of your body, or slurred speech. Also call 911 if someone taking opioids can't be woken up or has slow, shallow breathing.
Worried about the medicines you take now? Call (208) 613-3437 to set up a pain evaluation at our Jerome clinic.
Does Taking Opioids Long Term Mean You're Addicted?
No, taking opioids for a long time does not by itself mean you're addicted. Physical dependence and addiction are two different things. Here's how they compare:
Physical dependence
- Your body has adjusted to the medicine
- You get withdrawal symptoms if you stop suddenly
- It’s an expected effect of taking opioids regularly
- It’s handled by lowering the dose slowly
Addiction (opioid use disorder)
- You feel driven to use the medicine and can’t control it
- You have strong cravings that are hard to resist
- You keep using it even when it causes harm
- It’s treated with medicines, often along with counseling
Tolerance is a related term. It means the same dose stops working as well over time. That's a reason to talk with your provider, not to take more on your own.
These are signs of misuse:
- Taking more than prescribed, or taking it more often
- Using opioids to get high
- Taking someone else's opioids
Never stop opioids suddenly. The FDA has linked sudden stops to serious withdrawal, uncontrolled pain, and psychological distress. Your provider can make a plan to lower your dose slowly.
Worried about your use or someone else's? Call the SAMHSA National Helpline at 1-800-662-4357. It's free, confidential, open 24/7, and available in English and Spanish.
What to Try When Painkillers Aren't Enough
If you've read this far and thought, "I've tried all of that," this part is for you. Pills aren't the only path. Several of these options target the spot where your pain starts.
Nerve blocks: An injection near a specific nerve that blocks it from sending pain signals. They're used for problems like sciatica and knee pain.
Ultrasound-guided joint injections. Ultrasound lets the provider see the needle in real time as it moves to the right spot.
Iovera cold therapy. An FDA-cleared device that applies cold to a targeted nerve to block pain signals.
Regenerative medicine therapies. These include PRP (platelet-rich plasma), which is made from your own blood. Researchers are still studying how well these therapies work.
Exercise and spinal manipulation. The CDC lists exercise therapy and spinal manipulation among non-drug options for some types of chronic pain, such as back pain.
For example, Iovera is FDA-cleared to relieve pain from knee osteoarthritis. Nerve blocks are also used for knee pain. If you take an NSAID every day for knee pain, these are options to ask your provider about. CDC guidance encourages making full use of non-drug and non-opioid options.
Not every option fits every person. An evaluation shows which ones make sense for your pain.
Getting Help from a Pain Control Clinic in Jerome
If your pain has lasted months and pills aren't the whole answer, a pain control clinic is a good next step. You can learnwhat a pain control clinic does, or read on to see what a first visit at our clinic looks like.
What to bring to your first visit
- A list of every medicine and supplement you take, including over-the-counter ones
- A pain diary showing when it hurts, where, and what helps or makes it worse
What happens at your first visit
- We review your history, symptoms, and goals.
- We build a treatment plan around your type of pain.
Nerve blocks and injections are often used when pain comes from a specific nerve or joint. Relief from a nerve block varies from person to person. Some people need more than one treatment.
Central Idaho Wellness Center is at 868 E Main St, Jerome, ID 83338. We're open Monday through Friday, 8 AM to 5 PM. We serve Jerome, Twin Falls, and the rest of the Magic Valley.
Call us at (208) 613-3437 to schedule today!