From the Guidelines
Non-opioid pain control options should prioritize acetaminophen and NSAIDs as first-line treatments, with consideration of gabapentinoids, topical treatments, and non-medication approaches for comprehensive pain management. According to the most recent and highest quality study 1, nonopioid pharmacological therapies are typically preferred in the management of musculoskeletal or inflammatory pain, with acetaminophen widely used as initial therapy.
Medication Approaches
- Acetaminophen (Tylenol) at 325-650mg every 4-6 hours (maximum 3000mg daily) is effective for mild to moderate pain with minimal side effects.
- NSAIDs like ibuprofen (Advil, Motrin) at 400-800mg every 6-8 hours or naproxen (Aleve) at 220-500mg every 8-12 hours reduce inflammation but should be used cautiously in those with kidney issues, heart disease, or gastrointestinal problems.
- For neuropathic pain, medications such as gabapentin (300-1200mg three times daily), pregabalin (Lyrica, 75-300mg twice daily), or duloxetine (Cymbalta, 30-60mg daily) can be effective, as supported by 1 and 1.
Non-Medication Approaches
- Physical therapy, heat/cold therapy, TENS units, acupuncture, massage, and cognitive behavioral therapy provide additional relief options.
- Topical treatments like lidocaine patches, diclofenac gel, or capsaicin cream offer localized relief without systemic effects, as mentioned in 1 and 1.
- For procedural pain, nerve blocks or trigger point injections may provide targeted relief, as suggested by 1 and 1.
Multimodal Approach
A multimodal approach combining different classes of analgesic medications and non-pharmacological interventions can lead to additive or synergistic effects on pain relief and reduce side effects, as recommended by 1 and 1. This approach allows for tailored pain management strategies that prioritize patient safety and effectiveness.
From the FDA Drug Label
Those who responded to treatment were then randomized in the double-blind treatment phase to either the dose achieved in the open-label phase or to placebo. Patients were treated for up to 6 months following randomization Efficacy was assessed by time to loss of therapeutic response, defined as 1) less than 30% reduction in pain (VAS) from open-label baseline during two consecutive visits of the double-blind phase, or 2) worsening of FM symptoms necessitating an alternative treatment Patients were allowed to take opioids, non-opioid analgesics, antiepileptic drugs, muscle relaxants, and antidepressant drugs if the dose was stable for 30 days prior to screening. Patients were allowed to take acetaminophen and nonsteroidal anti-inflammatory drugs during the studies DIRECTIONS For Arthritis Pain Label • do not take more than directed (see overdose warning) adults • take 2 caplets every 8 hours with water
The options for non-opiate pain control include:
- Pregabalin 2, 2
- Acetaminophen 3
- Nonsteroidal anti-inflammatory drugs 2 These options are mentioned in the context of managing various types of pain, including neuropathic pain associated with diabetic peripheral neuropathy, postherpetic neuralgia, fibromyalgia, and spinal cord injury.
From the Research
Non-Opiate Pain Control Options
- Non-opiate pain control options are available for various types of pain, including neuropathic pain, acute postoperative pain, and chronic non-malignant pain.
- According to a study published in 2019 4, pregabalin, an antiepileptic drug, is effective in managing chronic neuropathic pain in adults, with doses of 150 mg, 300 mg, and 600 mg daily showing significant pain reduction.
- Another study from 1991 5 found that acetaminophen 1000 mg and the combination of acetaminophen 1000 mg and codeine phosphate 60 mg were effective in treating acute postoperative pain, with the combination showing better analgesic efficacy.
Non-Opioid Analgesics
- Non-opioid analgesics, such as ibuprofen and acetaminophen, can be used to treat acute pain, as shown in a 2017 study 6 that compared the efficacy of ibuprofen and acetaminophen with opioid and acetaminophen combinations.
- The study found that there were no statistically significant or clinically important differences in pain reduction among the treatment groups.
- A 2015 study 7 discussed the potential role of an extended-release, abuse-deterrent oxycodone/acetaminophen fixed-dose combination product for the treatment of acute pain, highlighting the importance of considering non-opioid alternatives.
Safe and Effective Prescribing
- A 2006 review 8 emphasized the importance of safe and effective prescribing of opioids for chronic non-malignant pain, recommending that opioids be initiated after an adequate trial of non-opioid analgesics and that patients be closely monitored for adverse effects.
- The review also noted that most patients with chronic non-malignant pain can be managed with less than 300 mg/d of morphine (or equivalent), highlighting the need for careful dose titration and monitoring.