Is there a risk of addiction with strong analgesics?
Will I need stronger doses after a while?
What side effects can I expect?
Do I have to wait for pain to take my medicine again?
Is there a risk of addiction with strong analgesics?
Opioid analgesics, like morphine and dihydrocodeine, have long been associated with drug addiction, junkies etc. Today they are still legally referred to as ‘narcotics’ or ‘stupefying drugs’. So, fears of physical dependency and addiction to opioids for treatment of pain have been raised in the past.
Newer observations and modern developments refute this misconception. Fears were based on a small series of patients, and appear to be unsubstantiated when excluding patients with a history of substance abuse. Moreover, with the discovery of long-acting opioids, a major progress was made in the treatment of chronic pain: long-acting opioids result in more stable plasma levels, thereby allowing better prevention of pain at lower plasma levels and thus carrying low risks for addiction.
Opioids, however, should not be seen as a life-time sentence. The fear of becoming addicted is unnecessary in accordance with recent scientific insights. It is nevertheless recommended to gradually decrease the dose when stopping an opioid, as some functions in the body may have gradually responded to its presence over time, and may therefore need to return physiologically back to the initial status. Therefore, consult your doctor when you need to stop your medication once your pain is gone.
Will I need stronger doses after a while?
The fear to need invariably stronger doses to control pain is also widespread but refuted by scientists. Strong painkillers maintain their full effect and their dose should only be adapted to pain intensity: higher doses are needed if pain increases, but likewise the dose needs to be lowered if the pain becomes less intense.
What side effects can I expect?
In contrast with paracetamol, which is well tolerated when the dosing instructions are followed, other Level I drugs are associated with more side effects. Aspirin, as well as other non-steroidals or antiphlogistic drugs, can be harmful to the stomach and lower intestine, causing gastric discomfort or ulceration. Always take your medication with your meals. If you continue to suffer from a heavy or painful stomach, consult your doctor. He may prescribe a drug to protect against gastric damage. When taking aspirin or NSAIDs, caution needs to be taken for other rare side effects, such as increased bleeding tendency or wheezing in susceptible asthmatics due to increased muscle tone in the bronchi of the lungs.
Opioids can cause nausea and drowsiness, which usually disappear after some time. Constipation is also commonly reported, but this can be countered with sufficient intake of fluid and fibres, physical exercise and laxatives if needed. Ask your doctor.
Do I have to wait for pain to take my medicine again?
In chronic pain conditions, pain medications should always be taken according to a fixed dosing scheme and not on demand. This helps to downregulate the nerve excitability.
When installing treatment for chronic pain, the use of a ‘pain scale’ from “0” (no pain) to “10” (worst pain imaginable) may be helpful for the patient and his/her doctor alike to evaluate the pain evolution on a relative basis (see also "How is pain diagnosed?").
Regular evaluation of your pain, especially average pain during the day, pain at its least, pain at its worst, may help your physician to select the adequate pain treatment and monitor the efficacy of the prescribed treatment.
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Item code: NPR/08-0056
Date of Preparation: July 2009
