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Medication and treatment for persistent pain
Persistent pain (also called chronic pain) is a complex condition and so we need to use different tools to
treat and manage it. Most people with persistent pain will need to take some kind of medication, but this is
usually only part of the picture. They will probably also have to try some other ways of managing their pain
as well.
How to help manage persistent pain

Develop a pain management plan with your GP
or specialist.

Learn what self-management steps you can
take. These can include eating well, staying
active and having a good sleep routine.

See your GP if you are suffering from anxiety
or depression. This is very common in people
who have persistent pain. Treating the
underlying anxiety or depression through
counselling, self-directed therapy or
medication will help your pain.

Talk to your GP about whether you would
benefit from seeing a specialist psychologist,
physiotherapist or occupational therapist. Your GP may refer you to one or more of these health
professionals.


Try relaxation activities like tai chi and meditation, which can really help to manage persistent pain.
Make sure you have enough support – perhaps find a support group for your condition or simply a
community group. It is easy for people with persistent pain to become socially isolated, which does not
help their condition.
Medications for persistent pain
Paracetamol
Paracetamol is a simple but effective pain reliever (painkiller) and it can help in some persistent pain
conditions, such as arthritis. As long as you take it as prescribed, it is very safe with few side effects.
However, it is unlikely to help much with neuropathic, or nerve-type, pain.
Non-steroidal anti-inflammatories (NSAIDs – ibuprofen, diclofenac, naproxen)
These medications can be effective in reducing pain and inflammation, but they can cause complications,
such as kidney, stomach and heart problems, if you use them for a long time. You should not take this type
of medication for more than a week unless your GP is supervising your treatment.
HealthInfo reference: 83781
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Issued: 30 September 2016
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Page 1 of 2
Medication and treatment for persistent pain
www.healthinfo.org.nz
Antidepressants (amitriptyline, nortriptyline)
You might be confused if your doctor suggests trying an antidepressant to treat your pain, but it's not
because they think the pain is all in your head. Tricyclic antidepressants also block the signals that
overactive nerves send out, which makes them very effective in treating neuropathic pain.
These medications can cause drowsiness, so people usually take them at night, which can also help if the
pain is disturbing your sleep. But they can also cause some people to get a dry mouth.
If your doctor has prescribed an antidepressant, it's important to give it time to work. Some people notice a
difference in just a few days, but in others it can take several weeks to work. It is best to try this medication
for at least four to six weeks to see if it is working.
Venlafaxine is a different type of antidepressant that can also be used to treat persistent pain.
Anti-epileptic medication (gabapentin, sodium valproate)
Some types of epilepsy medication can also be used to treat persistent pain. They can block the nerve
impulses that cause pain.
It is best to start this type of medication at low doses and gradually increase it until the right dose is found.
This means it can take a while to start working, so it is important to keep taking the medication.
Capsaicin cream (Zostrix)
This cream blocks the nerves causing pain. Usually, you will first feel a warm, almost burning, sensation
but this quickly eases. The cream irritates some people's skin, so stop using it and see your GP if this
happens to you. See DermNet NZ – Capsaicin for more information about capsaicin cream.
Opiate pain relievers (codeine, morphine, oxycodone, tramadol)
These strong pain relievers can be effective in treating acute pain and a few
cases of persistent pain. They are not very effective in treating neuropathic
pain, or neuralgia, which respond better to the medications mentioned above.
There are some important issues with opiate pain relief medicines:


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They don't work well in neuropathic pain.
They can cause drowsiness, nausea, constipation.
Generally they become less effective over time as the patient becomes used to them (known as
tolerance), which means the person needs a larger dose for the same effect. This can be a problem in
treating long-term pain.
Dependence can be a problem with opiate pain relievers, but most people will not become addicted. The
people most at risk are those who have had addiction problems in the past. If you are taking opiates this is
unlikely to be an issue as long as you take them only as prescribed.
If you are prescribed opiates, your GP will need to see you regularly, so they can monitor how well the
medication is working and keep track of any problems. They may ask you to sign an agreement outlining
your pain relief goals and a plan for your prescriptions. Try not to be offended by this process. It is in place
to make sure that you get the best treatment possible.
Written by HealthInfo clinical advisers. Approved by Burwood Pain Management Centre clinical coordinator. Updated
October 2014.
Images courtesy of FreeDigitalPhotos.net; meditation by stockimages; sleeping woman by photostock.
83781
HealthInfo reference: 83781

Issued: 30 September 2016

Page 2 of 2