Occasional: For a garden-variety tension headache, first try acetaminophen (Tylenol), says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at Beth Israel Medical Center in New York City. "It's the safest of all the over-the-counter pain relievers at recommended dosages," he says. If your headache doesn't disappear, choose a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen (Advil) or naproxen sodium (Aleve), Fishman suggests. Aspirin also works, but because it has a slightly higher risk for gastrointestinal bleeding, most doctors don't recommend it for more than a few days in a row, says Portenoy. Aspirin for heart disease prevention is taken at a lower dose.
You need something stronger: If the pain persists, talk to your doctor about a prescription-strength NSAID (Voltaren, Anaprox, Celebrex). For severe headaches, you may be prescribed drugs that contain butalbital (a barbiturate), caffeine, and either aspirin (Fiorinal) or acetaminophen (Fioricet). Migraine sufferers are often helped by triptans (like Imitrex or Zomig). If the headache becomes chronic, your best bet is to work with a doctor or pain specialist to find the right drug cocktail (this is true with any kind of ongoing pain; go to painmed.org/patient to find a specialist). Drug options include short-acting opioids (Percocet, Vicodin), antidepressants such as Effexor or Cymbalta, which double as analgesics, and antiseizure medications like gabapentin (Neurontin) or pregabalin (Lyrica), recently approved as the first drug to treat fibromyalgia.
2. Menstrual Cramps
Regular monthly discomfort: Take an over-the-counter NSAID. "Studies have shown that these are more effective than acetaminophen in reducing this kind of pain," says Portenoy.
You need something stronger: Your doctor may suggest a prescription-strength NSAID. Another option is suppressing your cycle with birth control pills, or—if the pain is bad enough—a short-acting opioid.
Get the remedies for back and joint pain
Flare-up: For the random spasm or ache, grab some Tylenol. "Most acute back pain is not inflammatory, so for many people, taking an analgesic like acetaminophen may be all they need," says Portenoy. When this doesn't work, then try an NSAID.
You need something stronger: When you're in agony, or the discomfort doesn't relent in several days, ask your doctor about a combination drug such as Tylenol with codeine, a prescription NSAID, or a short-acting opioid. Drugs for chronic back pain include antidepressants, antiepileptics, muscle relaxants such as cyclobenzaprine (Flexeril), and long-acting opioids like OxyContin.
4. Joint Pain
Once in a while: For the occasional achy hip or shoulder, either acetaminophen or an NSAID (which may help more if there's inflammation) should do the trick, says Fishman.
You need something stronger: Treatments include prescription-level NSAIDS, muscle relaxants, short-acting opioids, and corticosteroid shots. Chronic pain patients may also be prescribed the new fibromyalgia drug Lyrica, as well as certain antidepressants.
In addition to medication, a number of complementary treatments—including acupuncture, guided imagery, cognitive and physical therapy, massage, and hydrotherapy—can help ease pain. Mindfulness meditation in particular has proven to be incredibly effective, says Jon Kabat-Zinn, PhD, author of Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Begin by simply focusing on your breath. Pay attention to every inhalation and exhalation through your nostrils. Picture the breath circulating all around your body, then imagine breathing specifically through the area where the pain is located. If you have a headache, for example, visualize the breath going through a hole at the top of your head; for menstrual cramps, it would flow through your pelvis. Do this for five to 20 minutes, and you should begin to notice the pressure diminish.