Effects of Chronic Pain Medications on Cardiovascular Health: A Narrative Review

Cardiovascular disease (CVD) and chronic pain are leading causes of morbidity and functional disability worldwide, and there is increasing evidence demonstrating that chronic pain may elevate the risk for major adverse cardiac and cerebrovascular events. Given the intertwined nature of the cardiovascular and pain regulatory systems, medications used for chronic pain management may also contribute to the risk of cardiac events due to their cardiovascular side effects. This literature review critically evaluates the impact of the most commonly prescribed pain medications on the cardiovascular system. Medications discussed include non-steroidal anti-inflammatory drugs (NSAIDS), acetaminophen, opioids, antidepressants, gabapentinoids, and intra-articular injections. In each case, factors such as dosage and patient predispositions are considered in how they change a clinician's response in order to achieve the best patient outcome. A comprehensive literature search was performed on multiple databases, including PubMed, Google Scholar, and ScienceDirect, up to April 2026. For each drug class, cardiovascular risk was evaluated in the context of dosage and patient-specific predisposing factors, and weighed against the degree of pain relief provided. By drawing attention to this issue, our aim is to enhance understanding of drug mechanisms and identify appropriate treatment options, ultimately fostering better clinical practices and evidence-based initiatives in this healthcare endeavor.