Medication Treatment Options for Pain

Medicines used to manage pain can be classified in one of the following categories:

  • Acetaminophen (e.g. Tylenol®)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), (e.g. Advil®, Aleve®)
  • Opioid analgesics, also known as narcotic medications, (e.g. morphine, methadone, Oxycontin®)
  • Adjuvant medications (e.g. Pamelor®, Neurontin®)


Acetaminophen (Tylenol®) is usually the first drug to consider for treating mild to moderate pain in older adults. The maximum daily dose of acetaminophen is 4,000 mg, which is equivalent to eight tablets of Extra Strength Tylenol® per day. Use of higher doses can damage the liver. Doses should be spaced about six hours apart. The maximum dose should be less if the individual has liver or kidney impairment. Alcohol should be avoided while taking acetaminophen.

Acetaminophen is an ingredient in numerous over-the-counter products, including cough and cold products. Examples of products that include acetaminophen are:

  • Nyquil®
  • Excedrin® Aspirin-Free Caplets
  • Pamprin® Maximum Pain Relief Caplets
  • Sominex® Pain Relief Formula
  • Sinutab® Sinus Caplets

Acetaminophen is also found in many prescription pain relief products, including:

  • Vicodin®
  • Midrin®
  • Esgic®
  • Percocet®

It is important to read product ingredients carefully to ensure that the maximum daily dose of acetaminophen is not accidentally exceeded from a combination of multiple products taken.

Get more information about acetaminophen.


Nonsteroidal Antiinflammatory Drugs (NSAIDs)

This family of pain relievers contains many members. Examples of medicines in this class include:

  • Aspirin (the oldest NSAID medicine)
  • Ibuprofen (Advil®, Motrin®)
  • Naproxen (Aleve®, Naprosyn®)
  • Ketoprofen (Orudis®)

All of the above NSAIDs are available without a prescription. Some examples of prescription NSAIDs include:

  • Voltaren® (diclofenac)
  • Clinoril® (sulindac)
  • Mobic® (meloxicam)

For short-term use, NSAIDs are generally safe and effective for mild to moderate pain. With chronic (long-term) use, NSAIDs can increase blood pressure and can worsen heart failure by causing sodium and water retention. Persons with high blood pressure, heart failure, or kidney disease should check with a doctor before taking these medicines on a long-term basis.

Long-term use of NSAIDs, such as for arthritis, can also increase the risk of ulcers and gastrointestinal bleeding.

Certain NSAIDs are considered to be especially likely to cause problems in older adults. These medicines should generally be avoided since safer alternatives are available:

  • Toradol® (ketorolac)
  • Daypro® (oxaprozin)
  • Indocin® (indomethacin)
  • Feldene® (piroxicam)

Celebrex® (celecoxib) is a type of NSAID that selectively inhibits a particular enzyme (cyclo-oxygenase-2), and is less likely to cause peptic ulcers than traditional NSAIDs.


Opioid Analgesics (Narcotics)

Examples of opioid analgesics include:

  • morphine
  • methadone
  • Oxycontin® (oxycodone)
  • Dilaudid® (hydromorphone)
  • Duragesic® (fentanyl)

Opioid analgesics are also available as combination products, usually combined with acetaminophen. Examples of these combination products are:

  • Lortab®
  • Percocet®
  • Percodan®
  • Vicodin®
  • Tylox®

Opioid analgesic drugs are used to help relieve moderate to severe pain. They may be used for acute pain, such as following surgery or an accident. They are also used to relieve pain in certain chronic conditions, such as cancer or other painful diseases.

True addiction in older adults with persistent pain is rare. Concerns over drug dependency and addiction should not stand in the way of relieving the pain.

Certain opioid drugs should be avoided in older adults. Darvon® and Darvocet® are examples of medicines that contain propoxyphene, a drug which is not very effective as a pain reliever even though it has similar side effects as other opioid medicines. Demerol® (meperidine), and Talwin® (pentazocine) should also be avoided in older adults because they have more side effects than other opioids.

When used for longer than one or two weeks, constipation can be a significant problem with opioid medicines. Laxatives, fluids, and enemas can be used for symptomatic management of constipation with opioids.

Download this patient education fact sheet about opioid medicines (PDF).


Adjuvant Analgesics

At times, medicines called adjuvant analgesics are also used to help manage pain. These are medicines that can be useful for certain kinds of pain, such as pain from shingles (herpes infection). These medicines might also be used in combination with traditional pain medicines to help manage severe pain. Examples of these adjuvant analgesics could include certain medicines that are normally used to treat depression or epilepsy.