Should you take pills or use patches for pain relief?

We all want effective pain remedies, and pills and patches are common options. Both are available with prescription or nonprescription active ingredients. But which is best to relieve discomfort: a pill or a patch?

How they work

Pain pills and pain patches deliver medication in different ways.

When you take a pain pill, its active ingredients are absorbed through the gastrointestinal tract, broken down in the liver, and sent to the bloodstream for quick distribution throughout the body.

Patches are placed on the skin (see "Common pain patches"). The active ingredients work locally, and they are absorbed into the bloodstream more slowly and to a lesser degree than the active ingredients in pain pills.

Differing downsides

Pain pills and patches have their own sets of potential problems.

For example, pain pills

• might be hard to swallow for some people
• might not be absorbed well, due to digestive health or diet issues
• might interact with another drug being processed in the liver, causing dangerously high or low levels of either drug
• might cause gastrointestinal side effects such as nausea, ulcers, or stomach bleeding, depending on the drug.

In contrast, pain patches

• are slower to start working, which isn't ideal for sudden or immediate (acute) pain
• might cause skin irritation at the site where you apply it
• might not be available with the active ingredient you need.

Benefits

Pain pills and patches have their own distinct benefits.

For example, because pain patches work slowly, they provide a steady stream of medication over an extended period. That can be helpful for chronic pain or long-term recovery from an injury.

"Patches are also convenient for people with swallowing difficulties or those who have a hard time remembering to take pills. And because patches are absorbed through the skin, you avoid the gastrointestinal side effects and potential interactions," says Dr. Sanjeet Narang, a pain medicine specialist and director of the Arnold-Warfield Pain Center at Harvard-affiliated Beth Israel Deaconess Medical Center.

In contrast, pain pills work quickly. That's important if you need rapid relief of your pain, like a sudden pounding headache or a backache from doing too much yardwork. For rapid relief, an over-the-counter painkiller like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) is the best approach. Following surgery or for various chronic pain conditions, over-the-counter pills might not be enough: prescription pills such as gabapentin (Neurontin) or even opioids such as oxycodone (OxyContin) may be required.

Which one is right for you?

Dr. Narang says that pills are typically preferred for acute pain requiring rapid relief, but both pills and patches work for chronic pain. "The ones we prescribe or recommend depend on your needs. And in some cases, we'll advise patients to use a combination approach of both patches and pills," he says. Creams or ointments you rub on your skin are another option, which we will discuss at length in a future article.

Another important consideration is medication risk. For example, regular, long-term use of NSAIDs can irritate the stomach lining and cause ulcers or stomach bleeding. Even short-term use of NSAIDs slightly increases the risks for heart attack and stroke. And opioids can be addicting and even life-threatening if you take too many.

So, talk to your doctor before trying something new, even if it's just an over-the-counter pain pill or patch you see in the drugstore; it might have a risk you don't know about.

And if you ever experience sudden, extreme pain — such as the sudden onset of the worst headache of your life, or sudden chest or abdominal pain — don't diagnose yourself. Call 911 or your doctor.

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