and breakthrough pain with chronic conditions or
during recovery from injury or surgery.
NARCOTICS AND ADDICTION
Many people, including doctors, are fearful of
the potential for addiction with long-term use of
NARCOTICS(OPIATES). However, numerous studies
show that addiction is very rare, affecting fewer
than 1 percent of people who take opiates for
severe CHRONIC PAIN. Pain alters the mechanisms
in the BRAINthat respond to opiates such that
these mechanisms do not interpret the effect of
the opiate as producing pleasure (a key factor in
addiction). As well, addiction involves a combi-
nation of physical and emotional factors that typ-
ically are not present in severe pain. The
unwarranted fear of addiction prevents many
people from taking or receiving enough medica-
tion to relieve their pain.Therapeutic ApplicationsAspirin, acetaminophen, and over-the-counter
NSAIDs are the most widely used medications in
the United States. They have numerous therapeu-
tic applications for mild to moderate relief from
pain, inflammation, and fever. Doctors generally
move to prescription medications when OVER-THE-
COUNTER(OTC) DRUGSare not effective or when the
nature of the pain is such that it exceeds their
ability to provide relief (such as after surgery or
significant injury). As knowledge and understand-
ing about the mechanisms of pain grow, doctors
are increasingly able to structure pain relief
approaches that integrate different kinds of drugs
for optimal effectiveness. The therapeutic applica-
tion of many analgesics is highly individualized.
Risks and Side Effects
Risks and side effects vary according to the med-
ication. It is possible to have an ALLERGYto any
analgesic, creating the potential for HYPERSENSITIV-
ITY REACTION. Though OVERDOSEis possible with any
analgesic, it is a particular risk with aspirin, aceta-
minophen, and NSAIDs. People are more likely to
self-medicate with these drugs and to take multi-
ple products that contain these drugs as ingredi-
ents without recognizing the cumulative amount
exceeds safety. These drugs also have a lower
threshold for hepatotoxicity (damage to the LIVER)
and renal toxicity (damage to the KIDNEYS), and
can cause irreversible LIVER FAILUREor RENAL FAIL-
UREeven when taken at recommended dosage lev-
els. Though many people worry about overdose
with narcotics (opiates), it is far less of a risk.
However, inappropriate use of narcotics has high
risk for addiction. Aspirin and NSAIDs also are
irritating to the gastrointestinal tract and may
cause bleeding.
Medications such as beta-blockers, calcium
channel blockers, and antiseizure medications
have particular risks associated with these classifi-
cations of drugs. Though people taking these
drugs for their primary intended purpose (cardio-
vascular conditions or seizure disorders, respec-
tively) are generally well aware of these risks,
people taking them for pain relief may not recog-
nize warning signs of adverse reaction. It is impor-
tant to weigh the potential benefits and risks of
taking these drugs for pain relief. Analgesic med-
ications also interact with numerous other med-
ications, including OTC products and herbal
remedies.
See also ALTERNATIVE METHODS FOR PAIN RELIEF;
ANESTHESIA; NEURORECEPTOR; SCHEDULED DRUGS.368 Pain and Pain Management