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🏥 Gotokuji Orthopedic Clinic / Patient Guide

Pain Medication Overview

A patient-friendly map of the 8 most-used pain medications in orthopedics, by pain type

❓"Pain Medication" Isn't One Thing

Pain comes in different flavors — inflammatory, neuropathic, and chronic — and different drugs are good at each.
"It didn't work, so I took another tablet" misses the point: the right approach is matching the type of pain to the right drug.
We tailor choices to your kidney, stomach, liver, and medication history to help reduce side effects.

⚙️How We Choose
1
Acute inflammatory pain

Joint or muscle inflammation → NSAIDs (loxoprofen) usually first

2
Sensitive stomach or kidneys

Switch to celecoxib (relatively less burden on the stomach) or acetaminophen (relatively less burden on gut and kidney)

3
Burning, tingling neuropathic pain

NSAIDs don't help — use pregabalin or mirogabalin instead

4
Stubborn chronic pain

Tramadol or tramadol/acetaminophen combinations may be added carefully

🫘 Reduced kidney function 🤢 History of ulcer 🍷 Liver disease 👴 Older adults 🤰 Pregnancy / breastfeeding
🔍Match Pain to Drug
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Inflammatory knee/shoulder/back pain → NSAIDs
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Sciatica or numbness → neuropathic pain meds
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Persistent dull chronic pain → tramadol-class
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Post-op acute pain → acetaminophen + NSAID
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Children, frail elderly, or sensitive stomach → acetaminophen first
💊The 8 Main Medications
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Loxoprofen (Loxonin)
Most-used NSAID. First line for acute inflammatory pain
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Celecoxib
Relatively less burden on the stomach. The package insert carries a boxed warning that celecoxib may increase the risk of serious cardiovascular events (heart attack, stroke) with longer use, so take it only for as long as needed
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Diclofenac (Voltaren)
Stronger but more side effects. Short-term use only
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Acetaminophen
Relatively less burden on the stomach and kidneys; useful for children and older adults. In pregnancy, use only as directed by your doctor
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Pregabalin / Mirogabalin
For neuropathic pain. Helps the burning/tingling kind. They can cause dizziness, drowsiness, and even loss of consciousness, so do not drive or operate machinery while taking them. Never change the dose or timing, or stop suddenly, on your own
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Tramadol
Moderate-strong analgesic for chronic pain. Manage constipation/nausea. It can cause dizziness and drowsiness, so do not drive or operate machinery while taking it. Do not change the dose or stop suddenly on your own
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Tramadol + Acetaminophen
Combination for stubborn chronic pain when others fail
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Nerve Block
When oral meds aren't enough — local injection at the source
📈How Treatment Progresses
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"Start low, adjust as we go"

We typically start with the lowest-risk option and adjust strength or class based on response and side effects. Neuropathic pain often needs a specific drug from day one. We check in every 1–2 weeks. If something isn't working, we switch — please don't increase the dose on your own.

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Things to share with us before starting.
① Kidney or liver disease · ② Ulcer history or blood thinners · ③ Older age and risk of falling from sedating drugs · ④ Possibility of pregnancy. With this information we can pick the safest effective option.

💡Using Pain Meds Safely

💡 4 Things to Remember

  • If a drug isn't working, ask — don't self-escalate the dose
  • Take NSAIDs with food, never on an empty stomach
  • If using tramadol-type meds, pair them with anti-constipation/nausea drugs
  • Wrong-class drugs don't help no matter how many you take. Identify the type of pain and switch the class

🩻 Gotokuji Orthopedic Clinic

We match the medication to your type of pain, with side effects kept in mind

📞 03-5451-7878

Weekdays 9:00-12:00 / 14:30-18:30　Sat AM only
5 min walk from Gotokuji Sta. (Odakyu) / Yamashita Sta. (Tokyu Setagaya)