• It is important to balance the medications’ benefit for pain reduction with that its side effects and risks
• Harm exists in both under-treating your pain as well heavily relying on medications and being over prescribed medications.

• All medications come with a potential for side effects; it is important to know what to expect when starting a new medication.

• Take your medications as prescribed.
• Be aware of common interactions with other medications and substances.
• Do not borrow medications
• Do not share your medications

• Know what, when, why, and how you take your medications.
• Maintain a current list of your medications (including herbals, vitamins, and over the counter medications) to share with your health care team.
• Your community and clinic pharmacists can help you.

• Store medications securely (e.g., locked or out of reach from kids and pets).
• Avoid areas of heat and moisture such as the bathroom or over the stove.
• Leave medications in their original labelled containers.
• Please bring back unused medications to your community pharmacist for appropriate disposal

 is caused by tissue damage or injury which affect pain sensors known as nociceptors. It may include pain due to inflammation such as arthritis, mechanical/compressive types of pain such as pain caused by expanding tumors or pain from inflammatory bowel disease.

is caused by a lesion or dysfunction in the nerve or the central nervous system. It may be peripheral such as diabetic neuropathy or post-herpetic neuralgia; or it may be central such as post-stroke pain, pain due to spinal cord injury or multiple sclerosis.

Pain that arises from changes in how the sensory systems responds to a harmful/ potentially harmful stimuli, despite no clear evidence of actual or threatened tissue damage or evidence for disease or lesions causing the pain.

This term helps describe pain that underlies many different chronic pain conditions, including fibromyalgia, complex regional pain syndrome, other types of musculoskeletal pain such as chronic low back pain, as well as visceral pain disorders such as irritable bowel syndrome and bladder pain syndrome.

• A simple analgesic used to relieve mild to moderate nociceptive pain.
• It is well-tolerated and relatively safe when taken appropriately.
• Acetaminophen is present in many over-the-counter products such as Tylenol®, Robaxacet® and cough and cold products e.g. DayQuil®.
• It is important to consider the amount of acetaminophen in these products so as not to exceed the Health Canada recommended daily maximum dose of 4000mg/day.
• However, it is also important to check with your primary care provider what your maximum daily dose should be, as it may be lower in liver disease, advanced age, or with chronic acetaminophen use.  

• This medication decreases inflammation, and changes the pain system in the brain and spinal cord.
• They are used to relieve nociceptive pain such as osteoarthritis.
• NSAIDs may cause stomach irritation, which in severe cases can lead to stomach bleeds and/or ulcers.
• They can also increase blood pressure, alter blood clotting, and may contribute to kidney damage and increases the risks of heart attacks and strokes
• NSAIDs can increase the risk of bleeding when combined with aspirin, anticoagulants, and some antidepressants.
• However, it is important to note that the body does not develop tolerance to NSAIDs, and they do not lead to physical dependence.

NSAIDs include ibuprofen (Motrin®, Advil®, Robax Platinum), naproxen (Aleve®) and celecoxib (Celebrex®). Celecoxib is a specific type of NSAID known as a COX-2 inhibitor. It carries a lower risk of stomach irritation, but may still affect your kidney and cardiovascular system.

• These medications can increase serotonin and norepinephrine levels in the nervous system and decrease overall pain sensation and in doing so can improve mood.
• Some commonly used antidepressants include duloxetine (Cymbalta®), venlafaxine (Effexor®) and the tricyclic antidepressants (amitriptyline, nortriptyline).
• There is evidence they may be useful in neuropathic pain, fibromyalgia and some arthritis (duloxetine). 

Below are dosing and side effect considerations:

• The proposed mechanism is by reducing the release of excitatory brain chemicals in the spinal cord and brain, thereby reducing the pain sensation.
• The anticonvulsants that have been shown to be effective in relieving neuropathic pain and fibromyalgia are gabapentin (Neurontin®) and pregabalin (Lyrica®).
• Gabapentin and pregabalin may cause drowsiness, dizziness, confusion, dry mouth, weight gain or headaches.
• These side effects are usually temporary and may be managed in different ways, such titrating up these medications gradually, or taking them at bedtime.
• Other anticonvulsants that have specific roles include carbamazepine (Tegretol®) for trigeminal neuralgia; and topiramate (Topamax®) for migraine prevention.

• Constipation, nausea and/or vomiting, dry mouth
• Sleepiness, dizziness and confusion
• Itching and sweating
• Reduced urge to breathe (respiratory depression)
• Medical complications that include:
  • Low levels of testosterone (lower sex drive, energy, strength and effects on fertility)
  • Increased fracture risk
  • Increased sensitivity to pain
  • Sleep apnea
  • Lower mood
  • Lower immunity
  • Addiction

• There is currently not a lot of good scientific evidence supporting the use of cannabis in chronic pain. 
• Medical cannabis has been shown in small studies
  to have some benefit in certain people with:
  • neuropathic or “nerve” pain
  • palliative and end-of-life pain
  • spasticity (multiple sclerosis or spinal cord injury)

Cannabis related side effects are primarily due to the THC content.  Harms occur more frequently in those who use cannabis daily, smoke cannabis and/or use high THC strains.  Cannabis can:

• Decrease thought-processing and reaction time
• Impair perception, memory, concentration, and decision-making
• Can cause cycles of severe nausea and vomiting
  (Cannabis Hyperemesis Syndrome)
• Lead to bronchitis, lung infections, and chronic cough
• Worsen symptoms of anxiety, depression, or can cause psychosis
• Worsen mania symptoms in bipolar disease and PTSD symptoms
• Lead to dependence or addiction

If you are:

• allergic to any cannabinoids
• pregnant or breastfeeding
• under the age of 25

If you have:

• history of heart or lung disease
• personal or family history of serious mental illness
• current or past cannabis use disorder or other substance use disorders