Pain killers

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.

Acetaminophen
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.

NSAIDs
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
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
Opioids are drugs that bind to opioid receptors to produce morphine-like effects. 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
Tricyclic antidepressants such as amitriptyline or clomipramine are commonly used in ME/CFS to treat chronic pain and to aid regular sleep.

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

Others
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.