Analgesic medication works by interrupting pain signal transmission or perception. It reduces the experience of pain. It does not change the conditions, mechanical, neurological, and inflammatory, that are generating the pain signal in the first place. For acute pain following tissue damage, this distinction is less critical. For chronic pain, it is everything.
The Tolerance Problem
Opioid analgesics become less effective over time through receptor downregulation. The dose required to produce the same level of pain relief increases progressively. In the context of a problem that is not self-resolving, this creates a trajectory toward ever-higher doses without ever addressing the underlying cause. Long-term opioid use for non-cancer chronic pain is associated with significantly worse functional outcomes than non-opioid approaches.
NSAID Use in Chronic Pain: The Nuances
Non-steroidal anti-inflammatory drugs reduce prostaglandin synthesis and are appropriate for acute inflammatory pain. In tendinopathy, which is a degenerative rather than inflammatory condition, they reduce the beneficial inflammatory response that is necessary for healing. Long-term NSAID use carries gastrointestinal, cardiovascular, and renal risks that accumulate with duration of use. They are not a long-term solution for most chronic musculoskeletal pain.
Medication that makes chronic pain more tolerable while the underlying condition continues untreated is not a treatment plan. It is symptom management.
The Evidence-Based Alternatives
Graded exercise therapy, sleep optimisation, dietary anti-inflammatory intervention, psychological approaches targeting pain catastrophising, shockwave therapy for specific tendinopathies, and acupuncture for a range of chronic pain conditions all have evidence bases that, for many conditions, equal or exceed that of long-term medication use. They address mechanisms rather than symptoms.