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Drugs for long-term pain

The use of drugs to treat pain is based on the World Health Organisation (WHO) analgesic ladder. This is a three-step approach:

The idea is to start at the lower rung of the ladder and move up until you reach a level that gives suitable pain relief. You should review your medication on a fairly regular basis to make sure you’re getting the best balance.

Alongside painkillers, there are many other drugs which can be introduced at any time while moving up the ladder. These drugs are commonly referred to as adjuvant drugs, which means they were originally used for something other than pain.

The most common adjuvant drugs used in the treatment of pain are:

  • antidepressant drugs (most commonly amitriptyline and duloxetine)
  • anticonvulsants or anti-epilepsy drugs (most commonly gabapentin and pregabalin).

Most drugs for pain are taken by mouth (orally) but some are available as patches, ointments or under-the-tongue tablets. Injected medication should be avoided in the treatment of long-term pain conditions due to possible side-effects.

Drugs used in the treatment of pain will often need to be taken on a long-term basis and will very rarely cure the condition. Most drugs have side-effects, so you’ll need to find a balance between the positive effects and any actual or possible side-effects. You should review your medication regularly to make sure that you’re getting the best balance.


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