Acetaminophen: Generally considered safe however high doses over extended periods of time can affect the liver. This is especially those who consume excessive alcohol.
NSAIDS: Medications like Ibuprofen (Advil), Naproxen (Aleve), Diclofenac (Voltairin), Celecoxib (Celebrex) etc. are called Non-steroidal anti-inflammatories. These drugs are safer if used intermittently. Chronic use may affect kidneys, blood pressure, heart, GI tract (ulcers/gastritis) and have occasionally been linked to stroke. Celebrex has been considered to be safer than the other ones, but it is not without risk. Although they are labelled as anti-inflammatories, they should not be assumed to ‘fix inflammation’. In chronic pain, these should be considered more as pain killers. They are not curative in any way and it would be incorrect to assume that they are treating the underlying problem. Therefore, when weighing the risks and benefits, the only assumed benefit should be pain relief. Emulgel (Voltarin Gel) may help if rubbed on certain joints such as the knee or shoulder.
Muscle relaxants such as cyclobenzaprine (Flexeril), Baclofen, tizanidine (Zanaflex) can help reduce muscle spasms. Most studies show that these medications work in the short term, but their effect tends to wane over time.
Narcotic pain medications such as morphine (Statex, M-Eslon, MS Contin), oxycodone (Percocet, Oxycocet, Oxyneo), hydromorphone (Dilaudid, Hydromorph contin), Fentanyl and Codeine (Tylenol #3) were quite popular in the past for managing chronic back pain. Recent literature has shown that in the long run, they are not useful in chronic pain. Over time, once patients become habituated to the drug, the pain score is no different than their pain score prior to taking the drug. In some patients, a phenomenon called opioid induced hyperalgesia may actually lead to worsening of pain.
Antidepressants: Cymbalta is an antidepressant that has been shown in a double blind placebo controlled trial to improve chronic back pain. It seems to have a dual mode of action which serves to improve mood as well as treat some of the underlying mechanisms of chronic pain. While the evidence is only for back pain, some practitioners have started to use it for other types of chronic pain. I have had mixed experience with this drug. In some people, it has worsened their mood. It seems to have a bimodal effect where some people do excellent while others are no better or have side effects. We generally need to treat about 6 patients to find one patient who has a 50% reduction in pain. If the patient is on a high dose then they sometimes need to be weaned off the drug slowly.
Neuromodulators such as pregabalin (Lyrica), Gabapentin, or Amitriptyline (Elavil) seem to help in neuropathic pain. Sciatica, which is a compression or irritation of the sciatic nerve is a form of neuropathic pain which in theory should respond to a neuromodulator.
a) In one study, Pregabalin (Lyrica) used up to 600 mg/day for up to 8 weeks was no better than placebo. Some patients noted initial benefit but it waned over time. This drug is more useful in fibromyalgia.
b) Gabapentin at a dose of 900 mg /day was shown to be of some benefit over placebo in chronic sciatica. Side effects include dizziness, vertigo, sleepiness or a feeling of being drug.
c) Amitriptyline (Elavil) is a 3rd line drug for neuropathic pain and is most helpful for migraines. One study showed then when Elavil (10 to 50 mg/day) was combined with Gabapentin (900 mg/day) about 50% noted benefit while 30% had to stop the Gabapentin due to side effects.
All 3 of the above drugs are associated with weight gain in some patients. Amitriptyline can also be associated with blurry vision and dry mouth.