What do pain management doctors prescribe for chronic pain?

October 9, 2025 •

4 min read

Over 50 million adults in the U.S. suffer from chronic pain, a condition defined as pain lasting longer than three months. For those seeking lasting relief, the critical question becomes: What do pain management doctors prescribe for chronic pain? The answer is a comprehensive and multi-faceted approach that moves far beyond simply prescribing medication.

Quick Summary

Pain management doctors address chronic pain using a personalized plan, which may include non-opioid medications, adjuvant drugs like antidepressants and anticonvulsants, and interventional procedures. Opioids are typically reserved as a last-resort option for severe cases.

Key Points

Multi-modal Approach: Pain management doctors use a combination of therapies, not just medication, to treat chronic pain, including physical therapy, injections, and psychological support.
Prioritizing Non-Opioids: Non-opioid medications like NSAIDs, acetaminophen, and COX-2 inhibitors are the first line of treatment for managing chronic pain due to lower risks.
Adjuvant Medications: Drugs originally developed for other conditions, such as antidepressants (e.g., duloxetine) and anticonvulsants (e.g., gabapentin), are commonly prescribed for their pain-relieving properties.
Limited Opioid Use: Due to high risks of addiction and dependence, opioids are now used cautiously, typically as a last resort for severe, non-cancer chronic pain and for limited durations.
Advanced and Interventional Techniques: Specialists can utilize nerve blocks, epidural steroid injections, spinal cord stimulation, and radiofrequency ablation to provide targeted, long-term relief.
Individualized Treatment: The best treatment plan is always tailored to the specific patient and their unique pain condition, emphasizing a collaborative approach between the doctor and patient.

A diagnosis of chronic pain requires a specialized and comprehensive treatment strategy that considers the patient's individual needs and the root cause of their discomfort. A modern pain management plan typically involves a balanced mix of medications, interventional procedures, and lifestyle adjustments, rather than relying solely on pharmaceuticals. The goal is not just to mask pain but to improve overall function and quality of life.

Non-Opioid Medications for Chronic Pain

Pain management doctors prioritize non-opioid medications, often as the first line of defense, due to the significant risks associated with long-term opioid use.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

For pain and inflammation stemming from conditions like arthritis or sprains, NSAIDs are a common prescription. While some are available over-the-counter, a doctor can prescribe stronger dosages. Potential risks include kidney issues, stomach bleeding, and heart-related complications, especially with long-term use.

Acetaminophen

Often used for mild to moderate pain, acetaminophen (Tylenol) is generally safer for the stomach than NSAIDs but can cause liver damage if taken in excessive doses or with alcohol. It is sometimes combined with opioids to minimize the amount of opioid needed.

COX-2 Selective Inhibitors

These are a special class of anti-inflammatory drugs, such as celecoxib (Celebrex), that specifically target the COX-2 enzyme, which is responsible for pain and inflammation. By blocking only COX-2, they reduce the risk of stomach-related side effects compared to traditional NSAIDs, though cardiovascular risks may be a concern.

Adjuvant Medications Used in Pain Management

Adjuvant medications are drugs originally developed for other conditions that have proven effective in managing chronic pain.

Antidepressants

Certain antidepressants, like tricyclics and SNRIs (e.g., duloxetine, venlafaxine), can help manage chronic nerve pain, headaches, and fibromyalgia. They work by interfering with the chemical processes that cause you to feel pain, and they can also help treat the depression that often accompanies chronic pain.

Anticonvulsants

Originally used to control seizures, anticonvulsant medications such as gabapentin (Neurontin) and pregabalin (Lyrica) can be very effective for treating nerve-related pain (neuropathic pain), characterized by burning or shooting sensations.

Muscle Relaxants

For chronic pain involving muscle spasms, a doctor may prescribe muscle relaxants. These are most often used for short-term relief, as their most common side effects are drowsiness and dizziness.

Opioid Medications

Opioids are powerful pain relievers but are typically considered a last resort for chronic, non-cancer pain due to the high risks of dependence, tolerance, and addiction. They work by binding to opioid receptors in the brain and body to block pain signals. Prescribing practices for chronic pain have become much stricter, focusing on short-term, low-dose use when other treatments have failed. Examples include hydrocodone, oxycodone, and morphine.

Interventional and Advanced Therapies

Beyond oral medications, pain management specialists employ advanced techniques to target the source of the pain more directly.

Injections

Epidural Steroid Injections (ESI): Used for back pain or sciatica, these inject anti-inflammatory medication directly into the epidural space around the spinal cord.
Nerve Blocks: Involve injecting an anesthetic near a specific nerve or group of nerves to block pain signals.
Facet Joint Injections: Target the small joints between vertebrae to relieve localized neck or back pain.

Electrical Stimulation

Spinal Cord Stimulation (SCS): An implanted device sends low-voltage electrical signals to the spinal cord, interrupting pain signals before they reach the brain.
Transcutaneous Electrical Nerve Stimulation (TENS): A portable, external device delivers a mild electrical current to the skin, offering temporary pain relief.

Minimally Invasive Procedures

Radiofrequency Ablation (RFA): Uses radio waves to heat and disable specific nerve fibers transmitting pain signals.
Intrathecal Pain Pump: An implanted pump delivers small, continuous doses of medication directly to the spinal cord, providing potent relief with lower dosages.

Comparison of Chronic Pain Medication Types


Medication Type	How It Works	Key Indication	Benefits	Risks
NSAIDs (e.g., Ibuprofen)	Blocks enzymes (COX-1 & COX-2) causing pain and inflammation.	Inflammatory conditions like arthritis, muscle pain.	Reduces both pain and swelling, available over-the-counter and by prescription.	Stomach bleeding, kidney issues, and potential cardiovascular risks.
Acetaminophen (e.g., Tylenol)	Blocks pain signals in the central nervous system, no anti-inflammatory effect.	Mild to moderate pain, osteoarthritis.	Fewer gastrointestinal side effects than NSAIDs.	Liver damage with high doses or use with alcohol.
Antidepressants (e.g., Duloxetine)	Interferes with chemical pain signals between brain and spinal cord.	Neuropathic pain, headaches, fibromyalgia.	Addresses both pain and often co-occurring depression.	Requires time to become effective, potential side effects like drowsiness.
Anticonvulsants (e.g., Gabapentin)	Quiets overactive nerve signals from damaged nerves.	Neuropathic pain (burning, shooting sensations), shingles.	Effective for nerve-related pain.	Dizziness, drowsiness, and potential weight gain.
Opioids (e.g., Oxycodone)	Mimics natural pain-relieving chemicals to reduce pain intensity.	Short-term severe pain, very selective long-term chronic pain.	Powerful pain relief.	High risk of addiction, tolerance, dependence, and overdose.

Conclusion

Pain management doctors take a highly individualized and cautious approach to treating chronic pain, moving away from relying solely on opioids. They utilize a robust toolkit that includes a wide array of non-opioid medications, adjuvant drugs, and advanced interventional procedures to target pain at its source. The ultimate goal is to create a comprehensive pain management plan that focuses on improving a patient's function and quality of life, with medication being just one piece of a larger, more integrated strategy. Patients are encouraged to work closely with their healthcare team to explore all appropriate options and find the most effective and safest path to relief. More information about chronic pain can be found from authoritative sources like the CDC.

Frequently Asked Questions

NSAIDs (e.g., ibuprofen) reduce both pain and inflammation by blocking certain enzymes, making them suitable for inflammatory conditions like arthritis. Acetaminophen (Tylenol) primarily works to reduce pain, with no significant anti-inflammatory effects.

Certain antidepressants, like SNRIs and tricyclics, can help manage chronic nerve pain, headaches, and fibromyalgia by affecting pain signals between the brain and spinal cord. A low dose is often used, and it does not necessarily mean the patient is depressed.

Due to high risks, opioids are typically a last-resort option for severe chronic pain, such as cancer-related pain, that has not responded to other treatments. When prescribed, it is usually for the shortest duration possible and with close monitoring.

Interventional pain procedures are minimally invasive techniques performed by specialists to target and treat the source of pain directly. Examples include epidural steroid injections, nerve blocks, and radiofrequency ablation.

An intrathecal pain pump is an implanted device that delivers continuous, small doses of pain medication directly into the spinal fluid. This provides targeted relief with significantly lower doses than oral medication, reducing systemic side effects.

Yes. Physical activity and exercise are often crucial components of a pain management plan. A physiotherapist or exercise physiologist can create a safe routine to improve strength, flexibility, and mobility, which can reduce pain over time.

Yes. In January 2025, the FDA approved suzetrigine (Journavx), a novel non-opioid painkiller that works by blocking a new pain-signaling pathway. It was approved for moderate to severe acute pain, representing a major development in non-opioid treatment.

Adjuvant analgesics are medications with a primary indication other than pain that also have pain-relieving properties. Common examples include certain antidepressants and anticonvulsants that are used to enhance the effects of other pain treatments.