Should you worry about painkiller addiction?

We all have a picture in our minds of heroin addicts, usually sad homeless people who live only for their next 'fix'. But most people don't realise that painkillers we can buy from our chemists can cause addiction too.

Headache, backache, osteoarthritis, stomach ache - your body is very good at telling you when you're in pain, and it's your nervous system that's responsible. Your brain is connected to every bit of your body via a complex network of nerves: below the neck, all these messages travel through your spinal cord. 'Motor' nerves carry messages from your brain telling each muscle to move; while sensory nerves carry messages back from your skin, limbs and body organs, telling your brain about touch, heat and pain.

Most parts of our body have pain sensors at one end of these 'sensory nerves'. Without them, you wouldn't move your hand away (quickly!) from a burning flame, or seek help if you had tummy ache.

Numb the pain

The aim of most painkillers is to damp down the sensation your brain gets from these nerve signals, or to reduce inflammation. Complicated chemical pathways in your body result in chemicals being released if there's inflammation or damage in any one part of your body.

Pain signals from muscles and joints, as well as cancer pain, usually respond well to painkillers like stronger opioid painkillers such as codeine or tramadol, or to medicines which work on the nervous system, like pregabalin and gabapentin.

But some painkillers can be highly addictive. We all know about heroin addiction - in fact, diamorphine (the medical term for heroin) has been the standard treatment for the pain of heart attack for decades. And heroin is part of the opioid family.

The medical definition of an addictive medication is that you need more and more as time goes on to have the same effect, and you crave it if you don't have it. Withdrawal symptoms include sweating and dizziness, anxiety and breathlessness, but also severe pain.

Even more worrying, some painkillers may make your body more sensitive to pain. If you're taking painkillers and you get pain, your instinct is to take more painkillers, which can end up feeding the addiction.

It's thought as many as one in three people with chronic headaches are actually suffering from 'medication overuse headaches' (also called medication-induced headaches). Your body adjusts to the painkillers, and you get withdrawal symptoms when levels in your blood drop. This causes a 'rebound' headache, and the obvious response is to reach for more painkillers. It's a particular issue for those who have migraine, who seem to be more prone to medication-overuse headaches.

Even 'simple' painkillers like paracetamol, or anti-inflammatory tablets like ibuprofen or naproxen, can become addictive if you take them at least three times a week for three months at a time. However, codeine-containing tablets are much worse. They can cause these headaches if taken just twice a week for three months or more, and it takes much longer to get over the headaches and aching that come with stopping them.

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Other painkiller risks

Anti-inflammatory medicines can cause severe stomach inflammation and damage your heart or kidneys if you take them for too long. So more and more people are being switched away from anti-inflammatories to opioids or nerve-damping tablets like gabapentin and pregabalin. At the same time, your risk of these conditions increases with age and obesity, and the UK population is living longer (and fatter) than ever.

So it's hardly surprising that the number of prescriptions issued in the UK for opioids has doubled in a decade, from 12 million to 24 million a year. And it's thought that up to 192,000 people could be addicted to them.

When to worry

Don't stop painkillers immediately if you're taking them for a long-term condition. But do ask yourself some serious questions if you're on regular doses of strong painkillers.

Firstly, have you been taking regular medication for over three months (it is possible to get addicted sooner but less likely)? If so, do you know exactly how many painkillers you take a day? Have you ever been tempted to take more than the prescribed dose? Do you find yourself running out of medicine before your prescription is due for renewal? Do you ‘borrow’ tablets from other people, including your partner, because you always seem to be running short? Do you pace the floor, waiting until you can take your next dose?

Dealing with pain isn't easy, and neither is helping painkiller addiction, but it is possible. If you've answered 'yes' to any of these questions, speak with your doctor. They will absolutely understand you're not a 'bad person' and will want to help. Your GP will be able to talk about services available. Options include pain management clinics, pain group work, physiotherapy specialist assessment and possibly counselling They may be able to offer a different short-term medicine to help you with withdrawal effects. Take along a family member for support if possible - you'll need their support along the way.

Thanks to My Weekly where this piece was originally published.