The management of acute pain (e.g., injuries, surgery) is usually straightforward. However chronic pain management can be complex, especially for chronic pain that is not due to cancer. Chronic pain management usually involves a multifaceted treatment plan that includes many pain management strategies. However whether pain is mild or severe, acute or chronic, medications are usually part of a pain management plan.
Pain medication: The "stepped" approach
When medications are used for pain, the type chosen depends on the type of pain, severity, what you have tried before, and any intolerance or allergies to medications that you may have. Mild pain can usually be managed with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, naproxen).
If pain is more severe or does not respond to previous medications, an opioid medication may be added. Generally, a weak opioid is used, such as codeine alone, codeine and acetaminophen, or oxycodone. If the pain is severe or doesn't respond to these medications, then a stronger opioid is used. Strong opioids are generally considered to be morphine, hydromorphone, and fentanyl. This gradual approach is called the "stepped approach" to pain management, initiated by the World Health Organization in the early 1980s.
Depending on the type of pain, other medications (called adjuvant medications) such as antidepressants, muscle relaxants, antiseizure medications, and anti-anxiety medications may be used to help control pain. Also, some herbal or natural products have demonstrated promising pain-relieving effects. Botulinum toxin and medical marijuana can also be helpful for some types of pain.
Pain management may also include non-medication strategies such as applying ice and heat, acupuncture, physical therapy, biofeedback, relaxation training, cognitive-behavioral therapy, massage and counselling. In some cases, transcutaneous electrical nerve stimulation (TENS) or surgery may be recommended. Your pain management team will suggest what is best for you, and together you will develop a plan to best manage and control your pain.