Analgesics

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A large variety of analgesics (painkillers) are used in ME/CFS to help relieve both chronic and acute pain. They are also used to treat pain associated with comorbid illnesses such as IBS or endometriosis.

Analgesics act in a variety of ways on the peripheral and central nervous systems and can be taken in combination or alone.

Determining which analgesic is appropriate involves considering both the severity and type of pain presented. The patient's response to previous analgesics may also be considered.

Types of Painkillers[edit | edit source]

Acetaminophen[edit | edit source]

Acetaminophen, also known as paracetamol or tylenol, is used to treat mild to moderate pain and fever and is classed as a mild analgesic. It can be administered by mouth, rectally, or intravenously, and effects last between two and four hours. It is usually available for purchase without a prescription.

Acetaminophen can be combined with NSAIDs and/or opioids for stronger pain relief.[1]

NSAIDs[edit | edit source]

Nonsteroidal anti-imflammatory drugs are a class of drugs which provide both analgesic (pain-killing) and antipyretic (fever-reducing) effects, and anti-inflammatory effects in higher doses. They range from mild to strong pain relief.

Commonly used NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, celecoxib, meloxicam, mefenamic acid, and nabumetone.

COX-2 inhibitors[edit | edit source]

COX-2 inhibitors are NSAIDs that directly target cyclooxygenase-2 (COX-2), an enzyme responsible for inflammation and pain. Some COX-2 inhibitors used in ME/CFS include celecoxib and meloxicam.

Opioids[edit | edit source]

Opioids are drugs that bind to opioid receptors to produce morphine-like effects.[2] They provide moderate to very strong pain relief. A large range of opioids are used to treat pain in ME/CFS. Some of these are codeine, tramadol, oxycodone, vicodin, hydrocodone, fentanyl and morphine.

Tricyclic antidepressants[edit | edit source]

Tricyclic antidepressants such as amitriptyline or clomipramine are commonly used in ME/CFS to treat chronic pain and to aid regular sleep.

Anticonvulsants[edit | edit source]

Anticonvulsants are a group of medications that were originally used in the treatment of epileptic seizures, but are increasingly used for other purposes, including the treatment of neuropathic pain.[3] Anticonvulsants commonly used for pain in ME/CFS include GABA analogs such as gabapentin (Neurontin) and pregabalin (Lyrica), and fatty acids such as tiagabine (Gabitril).

Medical marijuana[edit | edit source]

Medical marijuana in various forms is increasingly used to treat chronic pain, including neuropathic pain.[4] CBD oil, made from marijuana or hemp, is also gaining popularity as an analgesic.

Others[edit | edit source]

Other analgesic treatments for chronic pain include lidocaine infusions, ketamine infusions, steroid injections such as cortisone, and benzodiazepines such as diazepam. Low dose naltrexone has also been reported to reduce chronic pain in ME/CFS and fibromyalgia. A variety of supplements and herbs are also used to reduce pain.

For non-pharmacological pain relief such as TENS or massage therapy, see pain management.

Combinations[edit | edit source]

Adjuvants[edit | edit source]

Application[edit | edit source]

Topical[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. https://www.drugs.com/monograph/acetaminophen.html
  2. Hemmings, Hugh C.; Egan, Talmage D. (2013), Pharmacology and Physiology for Anesthesia: Foundations and Clinical Application: Expert Consult - Online and Print, Elsevier Health Science, p. 253, ISBN 1437716792, Opiate is the older term classically used in pharmacology to mean a drug derived from opium. Opioid, a more modern term, is used to designate all substances, both natural and synthetic, that bind to opioid receptors (including antagonists). 
  3. Rogawski, Michael A.; Löscher, Wolfgang (2004), "The neurobiology of antiepileptic drugs", Nature Reviews Neuroscience, 5 (7): 553-564, doi:10.1038/nrn1430, PMID 15208697 
  4. Jensen, Bjorn; Chen, Jeffrey; Furnish, Tim; Wallace, Mark (1 Sep 2015), "Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence", Current Pain and Headache Reports, 19 (10), doi:10.1007/s11916-015-0524-x 


The information provided at this site is not intended to diagnose or treat any illness.

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history