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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.
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:
- 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 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
- Muscle aches
- Dental problems
- Menstrual cramps
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
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
Risks of Analgesics
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
- Nausea or vomiting
- 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:
- Dry mouth
- Nausea or vomiting
- Mood changes
- Problems urinating
- Abnormal heartbeat
- Slowed breathing
- Brain damage
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?
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
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
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.
How To Beat Addiction to Analgesics
If you are concerned about your drug use, whether these are legal prescription drugs or illegal substances, there are various ways to beat your addiction to painkillers on your own.
One of the most important steps for recovery is first admitting you have a problem. You may have noticed you are showing painkiller addiction symptoms and cannot seem to stop your drug use. By accepting you have a drug problem and realizing that you need to make some changes, you can take the right steps toward receiving the help you need.
It can be helpful to open up to someone about your concerns. This may be a family member or a friend you trust. If you are close to the person, they may have already noticed some of the signs that you are addicted to painkillers and want to help you beat your addiction.
Talk to a loved one openly about your concerns and let them know how they can help you move forward. They may offer to speak with your doctor on your behalf and attend an appointment with you as moral support. Or, they may help distract you when you are experiencing cravings.
Having someone on your side can help significantly during the early stages of recovery.
Be kind to yourself, too. Recovery is not going to happen overnight, and you may experience slips. This is natural, and you should not beat yourself up about it.
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. Buprenorphine and methadone can help you manage withdrawal symptoms throughout the detoxification process. 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 program.
Recovery from opioid analgesic addiction is challenging without assistance. Find professional treatment today.