NSAIDs (Most Anti-Inflammatory → Least)
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Indomethacin Nociceptive, inflammatory Acute Acute gout Strong anti-inflammatory; higher CNS/GI adverse effects
Diclofenac Nociceptive, inflammatory Acute + Chronic OA (esp topical) Higher CV risk; topical less systemic exposure
Naproxen Nociceptive, inflammatory Acute + Chronic OA, tendinitis Longer duration; GI/renal risk
Ibuprofen Nociceptive (somatic), inflammatory Acute + Chronic MSK pain, OA flares GI/renal risk; ↑BP; ceiling effect
Celecoxib Nociceptive, inflammatory Acute + Chronic OA/RA, GI-risk patients COX-2 selective → less GI ulcer risk; still CV/renal risk
Acetaminophen
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Acetaminophen Nociceptive (mild) Acute + Chronic Baseline analgesic, combination therapy Liver toxicity risk; ceiling effect; safer in CKD than NSAIDs
Corticosteroids (Anti-Inflammatory Strength Similar; Ordered by Clinical Potency)
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Dexamethasone Inflammatory, cancer-related edema Acute Severe inflammation/edema Most potent per mg; long acting; hyperglycemia, insomnia
Methylprednisolone Inflammatory Acute Dose packs/flares Intermediate potency
Prednisone Inflammatory pain Acute (bursts) Radiculitis flares Not analgesic; treat inflammation; hyperglycemia, mood, BP
Voltage-Gated Sodium Channel Antagonists
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Suzetrigine Nociceptive (acute), mixed Acute Oral peripheral analgesia (Nav1.8) Emerging agent; selective peripheral action
Lidocaine Neuropathic (localized), procedural Acute + Chronic Topical neuropathic pain; procedures Helpful in PHN; systemic toxicity if misused
Antiepileptics (Neuropathic Pain Efficacy Strength)
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Carbamazepine Neuropathic (paroxysmal) Chronic Trigeminal neuralgia Gold standard TN; hyponatremia; CBC/LFT monitoring
Pregabalin Neuropathic, nociplastic Chronic DPN, fibromyalgia Strong evidence; edema; CKD dose adjust
Gabapentin Neuropathic Chronic DPN, PHN Sedation; CKD dose adjust
Oxcarbazepine Neuropathic Chronic Trigeminal neuralgia alt Hyponatremia
Lamotrigine Neuropathic (selected) Chronic Selected cases Rash/SJS risk
SNRIs (Descending Inhibition Strength)
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Duloxetine Neuropathic, nociplastic, chronic MSK Chronic DPN, fibromyalgia, chronic back pain Strongest analgesic evidence; nausea; BP monitoring
Venlafaxine Neuropathic Chronic Neuropathic alternative Dose-dependent NE effect; withdrawal risk
TCAs (Analgesic Strength > Tolerability)
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Amitriptyline Neuropathic, nociplastic Chronic Neuropathic pain + sleep Most potent TCA; anticholinergic; QTc
Nortriptyline Neuropathic Chronic Better tolerated TCA Still anticholinergic
NMDA Antagonists
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Ketamine Hyperalgesia, severe acute pain Acute Opioid-refractory pain Very potent acute analgesic; dissociation; BP elevation
Methadone Mixed, neuropathic component Chronic Severe chronic pain NMDA activity + μ agonist; QTc; complex kinetics
Opioids (Most Potent → Least Potent Relative to Morphine)
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Fentanyl Severe nociceptive Acute OR/ICU ~100× morphine potency; patch for opioid-tolerant only
Buprenorphine Mixed Chronic Pain + OUD overlap High receptor affinity; partial agonist; safer respiratory profile
Methadone Mixed, neuropathic component Chronic Severe chronic pain 3–10× morphine; QTc; long half-life
Oxycodone Severe nociceptive Acute + Chronic Severe acute pain ~1.5× morphine potency; misuse risk
Morphine Severe nociceptive Acute + Chronic Reference opioid Standard comparator
Hydrocodone Moderate-severe nociceptive Acute Short-term acute pain Often combined with APAP
Tapentadol Mixed Acute/Chronic Severe pain w/ neuropathic component μ + NE mechanism; less potent
Tramadol Mixed Acute/Chronic Selected cases Weakest μ effect; seizure risk; serotonin syndrome
Topical Agents
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
Topical Lidocaine Neuropathic Chronic PHN Strong localized effect
Capsaicin Neuropathic Chronic Peripheral neuropathy Moderate effect; initial burning
Cannabinoids
Drug Primary Pain Type(s) Acute vs Chronic Best Clinical Use Key Pearls / Major Cautions
THC Neuropathic (modest) Chronic Adjunct therapy Psychoactive; variable response
CBD Mixed Chronic Adjunct Limited high-quality evidence