Identifying the best medication for chronic pain depends on underlying causes and how severe your symptoms are.

Pain is a complex combination of psychological, social, and biological factors. This means it involves not just a physical response to injury but also the individual experiences and beliefs that shape how you perceive pain.

Pain can happen every day. Sometimes it’s temporary, like when you stub your toe. However, for many people, pain becomes a chronic challenge.

Chronic pain, which is generally considered to be pain that lasts longer than several months, doesn’t last for just a set amount of time. Chronic pain is usually pain that persists past what’s considered a typical healing time.

Many medications can treat chronic pain, but the best options may change based on your circumstances. For instance, the cause of your chronic pain, whether due to injury or a medical condition, should be considered when choosing a treatment plan.

When you’re living with chronic pain, over-the-counter (OTC) medications are a common go-to. They’re accessible, fairly affordable, and available without a prescription because they have a good safety margin when taken as directed.

Pain medications are known as analgesics. OTC options for chronic pain include:


Also known as paracetamol (brand name Tylenol) around the world, acetaminophen’s exact method of pain reduction isn’t well understood.

It’s sometimes classified as a COX inhibitor because part of its known function is blocking, or inhibiting, cyclooxygenase (COX). This is an enzyme that the body uses in prostaglandin production, which generates pain perception.

Acetaminophen is one of the most widely used OTC pain medications available. It’s in hundreds of products, from cold medications to sleeping aids.

Though it’s marketed for pain, acetaminophen may be less effective compared with other OTC products. This is because it doesn’t have significant anti-inflammatory properties.

Until recently, it was widely recommended for use throughout pregnancy, though warnings now suggest it should be used with caution.

Common side effects of acetaminophen use include:

  • blistering, peeling, or red skin
  • itching
  • hives
  • rash
  • facial swelling
  • swelling in the extremities
  • difficulty swallowing or breathing
  • hoarseness

Acetaminophen is the preferred medication for chronic pain if you live with kidney disease. This is because NSAIDs can increase the risk of acute kidney failure in people with reduced kidney function. However, it is not viable for people with liver disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are true COX inhibitors. They work by inhibiting COX-1 or COX-2 enzymes (or both). In this way, they block pain perception, but they also help decrease inflammation.

Common OTC NSAIDs include:

NSAIDs are considered first-line options for nociceptive pain — pain that’s caused by damage to body tissue. They’re used in chronic musculoskeletal conditions like osteoarthritis or chronic back pain.

Common side effects of NSAID use include:

  • nausea
  • vomiting
  • diarrhea or constipation
  • swelling of the feet or ankles (edema)
  • gastrointestinal bleeding or ulcers
  • blood pressure increase
  • dizziness

Topical products

Topical OTC products are commonly used as supplements to other forms of long-term pain management, helping when the pain feels extra intense.

They can come as sprays, creams, ointments, or adhesive patches.

A 2020 research review found OTC patches containing lidocaine and capsaicin creams both helped improve general chronic lower back pain to the point where they could be considered first-line treatment options.

Common side effects of topical analgesics include:

  • skin reddening
  • rash
  • burning sensation at the application site

When chronic pain is beyond OTC products, doctors have prescription-only options available. These include:

  • NSAIDs
  • adjuvants
  • opioids


Stronger NSAIDs are available through your doctor. These include:

These medications work in the same ways as OTC NSAIDs but have a stronger effect. They may not be suitable for everyone, which is why they’re not available to the general public.


Medications that provide pain relief as a secondary benefit are known as adjuvants. These are drugs that have another primary purpose, like treating mental health disorders or calming muscle spasms.

They include:

Adjuvants are not used as monotherapy for chronic pain. This means they are not used on their own as a treatment for chronic pain. They may be added to your treatment plan at any stage to help cover a broader range of your pain symptoms when primary analgesics aren’t satisfactory.

They’re known to be beneficial for chronic pain challenges related to osteoarthritis, neuropathy, and fibromyalgia.


Opioids are not the preferred option for chronic pain. Doctors prescribe them only when non-opioid medications aren’t effective. Even then, they’re prescribed at the smallest dosage to help decrease any risk of drug dependency.

Common opioids include:

Opioid side effects can be serious. They can include:

  • drowsiness
  • nausea
  • constipation
  • euphoria
  • slowed breathing
  • drug dependency

According to the National Safety Council, emerging research suggests that opioids may no longer be the most effective way of managing severe chronic pain. Acetaminophen and NSAID combinations appear to provide a better level of pain management.

Acetaminophen is the most common OTC analgesic used in the United States. Each week, approximately 52 million people use an acetaminophen-containing product.

Among prescription options, the use of opioids for chronic pain remains prevalent. According to a 2021 National Health Statistics Report, in 2019, 22.1% of adults with chronic pain took a prescription opioid within 3 months of the survey.

There are many ways you can manage chronic pain, however. When it comes to the most common “treatment,” medication isn’t necessarily top of the list. In fact, many cases of chronic pain don’t respond to medication alone.

Common non-medication approaches include:

So, what is the best medication for chronic pain? It depends on your symptoms, why you’re experiencing pain, how severe that pain is, and if you live with any conditions that might make certain drugs off-limits.

Acetaminophen and NSAIDs are common OTC products used to manage chronic pain. When they aren’t effective, your doctor can provide prescription options.

Many people assume opioids are the be-all-end-all when it comes to chronic pain management, but research suggests there are more effective treatment options that are less likely to cause dependence.