What are painkillers?

A large range of painkillers are available, from the simple treatments you can buy - such as aspirin, ibuprofen and paracetamol - to much more powerful medicines, often based on natural or synthetic opiates (morphine-type drugs), that should be prescribed by a doctor.

You may take painkillers for an acute, short-lived pain such as a muscle strain, period pains or toothache. But chronic and severe pain is also very common, such as joint pain from arthritis, low back pain, chronic headaches, and after an injury. 

Many people need to take painkillers, sometimes strong ones, on a long-term basis. Then there may be the risk that they will develop tolerance (needing more and more as time goes by to achieve the same effect) and become dependent on them (finding they cannot feel normal or get through the day without them). 

These are signs of addiction, and this may lead to ongoing painkiller use long after the pain has settled. This is sometimes known as a silent addiction - it starts as a legitimate use and the user doesn't fit the usual profile of a drug addict, or even see themselves as such. 

Others use painkillers, especially opiates, in the same way as other street drugs, buying them from illicit suppliers and taking them because of their sedating or other mood-altering effects. 

Addictive painkillers

The simple painkillers you can buy in a pharmacy or supermarket, such aspirin, ibuprofen and paracetamol, are not addictive. A person may become physically dependent on them in order to control pain and keep active, but won't become psychologically dependent, taking them even when they know they are doing harm.

However, there is a small risk of problems with the extra-strength formulations of these medicines that contain codeine as an additional painkiller. Although the dose of codeine is very low, it's a member of the opiate group of drugs - which includes morphine and heroin - and it can induce a feeling of calm, sedation or general wellbeing. Because of this opiate effect, addiction can occur and a person may experience withdrawal problems if they try to stop taking it. 

However, most painkiller addiction is related to more powerful analgesics, especially natural opiates and synthetic opioids (opiate-like drugs). These drugs, which you need a prescription to obtain, include:

• Higher strength codiene or dihydrocodeine
• Morphine
• Buprenorphine
• Diamorphine
• Oxycodone
• Pethidine
• Tramadol

These painkillers may come in the form of tablets, syrup, skin patches and sometimes injections.

As well as removing pain, they can induce a sense of wellbeing or euphoria. They may have a relaxing effect or cause a feeling of mental detachment. In some people and in larger doses they may act as sedatives, making people feel sleepy. 

Risks of painkillers

Like all medicines, painkillers can have side effects:

• Aspirin and ibuprofen, if taken in high doses or for long lengths of time, can irritate the gut causing bleeding and ulcers, or damage the kidneys
• Paracetamol, if taken in a very high dose, damages the liver
• All painkillers, even simple ones, carry the risk of inducing pain such as headaches and back pain
• Opiate painkillers may cause withdrawal symptoms such as shivers, aching joints, agitation, anxiety, depression, constipation, paranoia and other physical and psychological side effects

However, the greatest risk from opiates is addiction. Symptoms to watch out for include:

• Feeling that you need to take the drugs in order to feel 'normal'
• Finding you need to take higher doses to achieve the same effect
• Taking them even though you know that they are doing harm
• Adopting devious or even illegal means to get more painkillers

It's estimated that painkiller addiction affects at least 100,000 people in the UK. However, there is some controversy about how great the risk of addiction is when someone takes opiates for pain rather than as a street drug. 

It's important that when people have severe pain they are properly treated and don't miss out on adequate pain treatment for fear of addiction. And there is some evidence that the risk of addiction is much less when the drugs for pain relief are used appropriately, with close medical monitoring. There is no doubt that the vast majority of people, when prescribed these medications, use them correctly without developing addiction. 

Limiting your risk of addiction

If you have severe pain and need powerful painkillers, the aim is to help you stay on the right side of the difficult balance between pain relief and addiction.

Simple tactics include :

• Close monitoring by a doctor or nurse
• Never increasing your dose without first discussing with your doctor
• Increasing information to improve people's awareness of the risks of addiction
• Limiting packet sizes of over-the-counter painkillers (or prescription sizes of more powerful analgesics), with clear label warnings that they should only be used for a short period without medical advice
• Discussing all effects of your painkillers, both good and bad, with your doctor
• Never sharing or allowing anyone else access your painkillers
• Never buying them from a casual or illegal source
• Trying a combination of different pain management techniques (including complementary therapies, heat, stress relief etc)
• Not suffering unnecessarily - there are plenty of tactics and other treatments that your doctor can try in order to improve your pain management without necessarily increasing your dose of an painkillers

If you are concerned at all, talk to your doctor or medical team.