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Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There are many different pain medicines, and each one has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.

Over-the-counter (OTC) medicines are good for many types of pain. There are two main types of OTC pain medicines: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) are examples of OTC NSAIDs.

If OTC medicines don’t relieve your pain, your doctor may prescribe something stronger. Many NSAIDs are also available at higher prescription doses. The most powerful pain relievers are opioids. They are very effective, but they can sometimes have serious side effects. There is also a risk of addiction. Because of the risks, you must use them only under a doctor’s supervision.

There are many things you can do to help ease pain. Pain relievers are just one part of a pain treatment plan.

How Do Opioids Work?

Opioid drugs bind to opioid receptors in the brain, spinal cord, and other areas of the body. They tell your brain you’re not in pain.

They are used to treat moderate to severe pain that may not respond well to other pain medications.

Opioid drugs include:

Your doctor can prescribe most of these drugs as a pill. Fentanyl is available in a patch. A patch allows the medication to be absorbed through the skin.

Working With Your Doctor

You’ll need a prescription from your doctor before you start taking opioids. The doctor can adjust the dose as needed to help control pain.

You may receive around-the-clock doses to manage pain throughout the day and night. And your doctor may prescribe opioids to be taken “as needed” in case you have “breakthrough” pain — a flare of pain that you get despite round-the-clock doses.

While you’re on opioid pain medications, check in with your doctor regularly. Your doctor will need to know:

How your pain is responding to the drug

Whether you’re having any side effects.

Whether you have any potential interactions or medical conditions that could make you more likely to have side effects, such as sleep apnea, alcohol use, or kidney problems.

Whether you’re taking the drug properly.

Never change or stop taking any opioid medicine without first checking with your doctor. If a pain medication isn’t working as well as it should, your doctor may switch you to a different dose — or add on or try another drug.

When you’re ready to stop taking opioids, your doctor may wean you off them slowly — if you have taken them for a long time — to give your body time to adjust. Otherwise, you may have withdrawal symptoms.

What Are the Side Effects of Opioids?

One of the reasons why your doctor needs to manage pain medications so closely is that they can cause side effects, such as:

Gastrointestinal problems: You may have nausea and vomiting when you start taking opioids. It often passes after a few days. Try lying down for an hour or so after taking a dose, or ask your doctor for an over-the-counter or prescription nausea remedy.

Constipation is a common problem when you take opioids. They cause food to move more slowly through your system, which results in harder stools that don’t pass as easily. If you start having trouble:

Don’t wait more than 2 days without a bowel movement before getting in touch with your doctor.

Drink more water. This alone helps some people with mild constipation. But others may have to do more. Having a hot drink in the morning can get things moving through your GI tract. Avoid drinks with caffeine, like coffee and tea, and instead try hot water with lemon or herbal tea.

Ask if other drugs may help. Your doctor may recommend either a stool softener or laxative that you can buy at the drugstore. Other drugs are available by prescription. Lubiprostone (Amitiza), methylnaltrexone (Relistor), naldemedine (Symproic), and naloxegol (Movantik) are approved to treat constipation due to opioid use in those with chronic pain.

Cognitive issues: Some people just don’t feel like themselves when they start taking opioids. You may have:

Trouble staying focused
“Foggy” feeling or trouble thinking clearly
Slow reflexes

Don’t drive or operate heavy machinery while on opioids. It may take a week or more for you to start feeling normal again.

Opioids can be dangerous if you take them with alcohol or with certain drugs such as:

Some antidepressants and anxiety medications (particularly benzodiazepines such as alprazolam, clonazepam, and lorazepam)
Some antibiotics

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