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Updated on April 7, 2022

Analgesics

What are Analgesics?

Analgesics, also known as painkillers, are prescription or over the counter (OTC) medications that relieve pain. Although effective when used as indicated, analgesic misuse can lead to severe consequences.

Understanding the different types of analgesics, as well as their side effects and abuse potential, is essential to avoid adverse health outcomes.

Analgesics include both OTC and prescription medications, and come in a few different forms, including:

  • Capsule
  • Tablet
  • Liquid
  • Topical cream
  • 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).

Analgesics produce several biological effects, including:

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

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.

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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:

  • Tylenol (Acetaminophen)
  • Aspirin
  • Ibuprofen
  • Naproxen

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 analgesics include:

  • Gels
  • Ointments
  • Creams
  • Lotions
  • Sprays
  • 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

Risks of Analgesics

Despite their effectiveness in treating pain, analgesics carry side effects which range from mild to life-threatening.

In general, OTC analgesic side effects are less severe than those of 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 and Interactions

Opioid analgesic health effects vary depending on the drug, dosage, and method of consumption. 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

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?

Generally considered non-habit-forming, non-opioid analgesics have a low risk of 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
  • 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 pleasurable feelings, which interact with the brain's reward pathways. These feelings generate a cycle of reinforcement, leading 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 and Withdrawal 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

People addicted to an opioid analgesic can experience severe withdrawal symptoms. 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

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. This 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.

Treatment Options for Opioid Abuse & Addiction

There are several options for people suffering from opioid addiction. These include:

Medication-Assisted Therapy (MAT)

There are three medications approved to treat opioid use disorder: buprenorphine, methadone, and naltrexone. These medications are used only with medical supervision.

Buprenorphine and methadone can help you manage withdrawal symptoms throughout the detoxification process. Because of this, a person experiences reduced cravings for opioids, thereby restoring balance in the brain circuits.

Naltrexone is less commonly used, but it blocks your opioid receptors, making it impossible to get high. Medication-assisted therapy is most effective when combined with other forms of treatment.

Inpatient Programs

Inpatient programs are the most intensive and effective treatment options for opioid addiction.

These programs guide you through medically supervised detoxification, then behavioral therapy and other services (possibly including MAT), will be added to your treatment.

They typically last 30, 60, or 90 days. However, they may be longer if necessary.

Partial Hospitalization Programs (PHPs)

PHPs are also known as intensive outpatient programs (IOPs). They are the next most intensive type of treatment for opioid addiction.

They provide similar services to inpatient programs such as detoxification, behavioral therapy medical services, and custom treatments such as MAT.

The difference is that in a PHP, the patient returns home to sleep. Some programs will include transportation and meals, but this varies by program.

Partial hospitalization programs are helpful for both new patients and patients who have completed inpatient treatment and still need intensive recovery therapy.

Outpatient Programs

Outpatient programs work best for people who have a high level of motivation to recover. They create treatment programs that work around your schedule.

These programs can either be an effective treatment option for new patients or a part of an aftercare program for people who complete inpatient or partial hospitalization programs.

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

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Resources

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  1. Over-the-Counter Pain Relievers: MedlinePlus Medical Encyclopedia.” MedlinePlus, U.S. National Library of Medicine.
  2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).” Cleveland Clinic.
  3. Opioid Misuse and Addiction.” MedlinePlus, U.S. National Library of Medicine, 16 Dec. 2019.
  4. National Institute on Drug Abuse. “Prescription Opioids.” NIDA.
  5. National Institute on Drug Abuse. “Opioid Overdose Crisis.” NIDA, 20 Feb. 2020.
  6. Woller, Sarah A et al. “Analgesia or addiction?: implications for morphine use after spinal cord injury.” Journal of neurotrauma vol. 29,8 : 1650-62. doi:10.1089/neu.2011.2100.

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