Pain type guides medication prescribed
Somatic (nociceptive) pain: Acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs – caution in older adults) and opioids (long-acting preferred); trial of adjuvants (see Table 2) for refractory symptoms.
Neuropathic pain: Serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), anticonvulsants, lidocaine patch, tramadol and opioids. (SSRIs and NSAIDs often ineffective.)
Centralized pain/Fibromyalgia: TCAs (amitriptyiline, cyclobenzaprine), SNRIs (duloxetine) and alpha-2-delta ligands (pregabalin and gabapentin) are effective for conditions such as fibromyalgia. Serotonin-selective reuptake inhibitors (SSRIs) can also be useful. (Opioids are not indicated.)