Analgesic

Analgesics (painkillers) are medications that alleviate pain. Certain painkillers, such as acetaminophen, can be purchased over-the-counter. Others, such as opioids, need a prescription. Non-opioid analgesics are generally considered non-addictive, while opioid analgesics are highly addictive.
Evidence Based
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Analgesics, also known as painkillers, are prescription or over the counter (OTC) medications that relieve pain. Although they are effective pain relievers when used as indicated, analgesic misuse can lead to severe side effects, dependency, and addiction. Understanding the different types of analgesics, as well as their side effects and abuse potential, is essential in ensuring their proper use and avoiding adverse health outcomes.

Although highly effective in treating pain, some analgesics have a high risk of abuse, physical dependency, and addiction.

What are Analgesics?

As mentioned above, Analgesics include both OTC and prescription medications. They come in a few different forms, including capsule, tablet, liquid, topical cream, and injectables. The two main classes of analgesics are non-opioid analgesics and opioid analgesics. These classes work differently in the body and have different uses and risks.

Opioid Analgesics

Opioids, also known as narcotic analgesics or narcotics, are prescription medications used to treat severe pain. Some opioids are made from the opium plant, while others are synthetic (human-made). Common opioid painkillers include:

Opioid uses include treating pain resulting from:

  • Cancer
  • Surgery
  • Severe injury
  • Chronic pain from conditions such as rheumatoid arthritis

Prescription opioid misuse is common. Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.

Non-Opioid Analgesics

Non-opioid analgesics include both OTC and prescription medications. In some cases, combining non-opioid and opioid analgesics may enhance pain relief. Common painkillers in this category include:

  • Acetaminophen/paracetamol — Tylenol
  • Non-steroidal anti-inflammatory drugs (NSAIDS) — aspirin (Bayer), ibuprofen (Advil, Motrin), naproxen (Aleve)

Common non-opioid analgesic uses include management of:

  • Cold or flu symptoms
  • Arthritis
  • Headache
  • Muscle aches
  • Backaches
  • Dental problems
  • Gout
  • Menstrual cramps

Topical Analgesics

Topical analgesics, used to treat localized muscle or nerve pain, are applied directly to the skin rather than ingested. Topical formulations include gels, ointments, creams, lotions, sprays, or patches. Common types of topical analgesics include:

  • Counterirritants — Ingredients produce hot, cold, or tingling sensations, which distract from pain sensations
  • Topical NSAIDs — Commonly contain aspirin and work by decreasing pain and swelling when absorbed
  • Capsaicin — Capsaicin from hot peppers works to block pain signals from skin nerves

Analgesic Effects

Graphic human body showing symptoms.

Analgesics work by decreasing pain sensations in the body. In addition, different types of analgesics work in different ways. For example, NSAIDs block the activity of certain chemicals in the body. These chemicals, called cyclooxygenase (COX) enzymes, are involved in the production of biological factors involved in inflammation and pain.

Opioid analgesics work by binding to and activating opioid receptors on cells in the brain and spinal cord. When opioids activate these receptors, they block pain signals sent from the brain and trigger the release of pleasure-inducing chemicals into the body.

Analgesics produce several biological effects, including:

  • Pain relief
  • Decreased inflammation
  • Drowsiness
  • Relaxation
  • Euphoria

Risks of Analgesics

Icon with triangle signifying risk.

Despite their effectiveness in treating pain, analgesics carry the risk of side effects, which range from mild to life-threatening. In general, OTC analgesics have less severe side effects than prescription drugs. Opioid analgesics also possess a high risk of tolerance, dependence, and addiction.

Non-Opioid Analgesic Side Effects

Non-opioid analgesic side effects vary depending on the drug. Potential side effects include:

  • Stomach pain
  • Heartburn
  • Nausea or vomiting
  • Headache
  • Dizziness
  • Allergic reaction
  • High blood pressure
  • Liver or kidney damage
  • Stomach ulcers or bleeding
  • Heart attack or stroke

Opioid Analgesic Side Effects

Opioid analgesic health effects vary depending on the drug, dosage, and administration route. Long-term use of high doses increases the risk of severe side effects. Possible opioid side effects include:

  • Drowsiness
  • Dry mouth
  • Headache
  • Nausea or vomiting
  • Constipation
  • Nervousness
  • Mood changes
  • Problems urinating
  • Abnormal heartbeat
  • Hallucinations
  • Seizures
  • Dizziness
  • Fever
  • Rash
  • Confusion
  • Slowed breathing
  • Coma
  • Brain damage
  • Death

Drug Interactions

Two pills mixing equals dangerous

Analgesics may interact with other prescription and non-prescription drugs, resulting in dangerous side effects. Analgesic drug interactions may include:

  • NSAIDs — diuretics, warfarin, clopidogrel, apixaban, dabigatran, or rivaroxaban
  • Acetaminophen — alcohol, warfarin, isoniazid, diflunisal, carbamazepine
  • Opioids alcohol, anti-seizure medications, benzodiazepines, antibiotics, antidepressants, antifungals, antiretrovirals, sleeping medications, anti-psychotics, muscle relaxants

Always consult a medical professional before analgesic use. Tell your doctor about all supplements, OTC drugs, and prescription medications you are taking to avoid potentially dangerous drug interactions.

Are Analgesics Addictive?

Graphic of head filled with pills

Generally considered non-habit forming, non-opioid analgesics such as acetaminophen and NSAIDs have a low potential for abuse and addiction. However, prescription opioid misuse is common and quickly leads to addiction. Opioid misuse can include taking too much medication, taking medication in a different way than prescribed, using drugs not prescribed to you, or taking medicine to get high. Opioid dependence and addiction can quickly develop, leading to continued use despite negative consequences.

Why Are Opioid Analgesics Addictive?

Opioid analgesics bind to opioid receptors within the brain, triggering the release of certain chemicals. These chemicals produce euphoria and pleasurable feelings, which interact with the brain's reward pathways. These effects generate a cycle of positive reinforcement, which leads to repeated drug use. Over time, this cycle results in tolerance and physical dependence.

Tolerance is when a user must take more substantial doses of the drug to achieve the same results. Dependence occurs when the body adapts to repeated opioid exposure. When opioid use is stopped, severe physical reactions occur in the form of withdrawal symptoms.

Analgesic Addiction Symptoms

Opioid addiction symptoms vary from person to person and may include physical and psychological changes, including:

  • Feeling an intense need to use opioids regularly
  • Gradually needing to take higher opioid doses to achieve the same physical effects
  • Experiencing an inability to focus on routine daily tasks
  • Being unable to stop using the opioid on your own
  • Experiencing financial difficulties connected to opioid use
  • Resorting to dangerous behaviors to obtain the drug, such as stealing
  • Engaging in risky behaviors while under the influence of opioids
  • Experiencing withdrawal symptoms when stopping or limiting opioid use
  • Loss of interest in usual activities
  • Changes in eating or sleeping patterns
  • Isolation from loved ones
  • Poor hygiene

Analgesic Withdrawal

Stethoscope

Individuals addicted to an opioid analgesic medication can experience severe withdrawal symptoms when they stop using the drug. These symptoms can start several hours after halting medication use. Opioid withdrawal symptoms include:

  • Muscle pain
  • Bone pain
  • Sleep disturbances
  • Diarrhea and vomiting
  • Cold flashes
  • Uncontrollable leg movements
  • Severe opioid cravings

Analgesic Overdose

Icon of pill with warning sign

An individual can overdose on both OTC and prescription analgesics. An overdose occurs when a person uses enough of the drug to produce life-threatening symptoms or death. Overdoses can be accidental or intentional. For example, taking more than the advised dose of acetaminophen or NSAIDS can lead to organ damage and death.

Taking opioid medications at greater doses than prescribed or using them with other drugs, such as alcohol, can potentially lead to fatal overdoses. When someone overdoses on an opioid, their breathing may slow or stop. Without enough oxygen reaching the brain, they can quickly experience coma, brain damage, or death. Emergency medical treatment is needed to prevent serious health effects. A particular medication called naloxone is administered in the case of an opioid overdose. When administered by emergency medical personnel, naloxone blocks the drug's physical effects.

2018 data shows that 128 people in the U.S. die every day from opioid overdoses.

Analgesic Addiction Treatment

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Opioid addiction is a complex, but treatable, chronic disease. Most people need professional help and long-term care to achieve recovery. Treatment plans for opioid addiction vary from person to person, as no single treatment program is right for everyone. Opioid addiction treatment includes:

Recovery from opioid analgesic addiction is challenging without assistance. Find professional treatment today.

Resources

“Over-the-Counter Pain Relievers: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine, medlineplus.gov/ency/article/002123.htm

“Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).” Cleveland Clinic, my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaid

“Opioid Misuse and Addiction.” MedlinePlus, U.S. National Library of Medicine, 16 Dec. 2019, medlineplus.gov/opioidmisuseandaddiction.html

National Institute on Drug Abuse. “Prescription Opioids.” NIDA, www.drugabuse.gov/publications/drugfacts/prescription-opioids.

National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 20 Feb. 2020, www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis.

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Updated on: June 24, 2020
Author
Addiction Group Staff
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