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How do I know when I am taking too many painkillers?

I’ve recently been prescribed painkillers for osteoarthritis, but I don’t really like taking medication and worry about taking too many or becoming dependent on them.

How do I know when I'm taking too many painkillers?
Name withheld (submitted by email, winter 2016)

Dr Tom Margham says:

Dr Tom Margham

Simply put, you shouldn't be taking more than the instructions on the packet for over-the-counter preparations or on the label for prescribed medications.

In my experience, many people aren't using painkillers in the most effective way to manage their pain, using them too little rather than too much. The reasons for this are often related to myths that exist around painkillers.

Painkillers don't normally mask more serious problems

People worry painkillers will mask more serious problems. If you find yourself needing painkillers regularly for more than a week without a good explanation or diagnosis for your pain, then it’s worth speaking to your GP, practice nurse or pharmacist to get a proper assessment of your problem.

But normally painkillers won’t mask more serious damage.

Use painkillers at the right time and at the right dose

People worry that they'll become addicted to painkillers. This won’t happen in the short term and with most painkiller medications taken as prescribed or instructed.

There are some stronger painkillers that need careful monitoring when used for longer periods of time as the body becomes used to having them in the system. But these drugs are only available on prescription and should be monitored by a doctor to check for side-effects, make sure they're still necessary and assess if there are other problems developing with ongoing use.

Many of the common side-effects of stronger painkillers, such as constipation or nausea, can be managed with input from your doctor or pharmacist. 

I completely understand why people worry that they'll come to rely on painkillers. But when used properly, at the right time and the right dose, they can help people to get back to normal activities, sleep well and do the things they enjoy more quickly. Unfortunately, people tend to suffer with pain and wait for it to become really bad before taking a dose of painkillers, rather than using the clock to gauge when to take the next dose.

Use painkillers regularly at the lowest dose needed

I advise people with joint and back pain to use painkillers regularly, at the lowest dose needed to control their pain and allow them to get back to normal activities. Sometimes this means planning ahead – if you have osteoarthritis in your knees and know you have a busy day on your feet ahead of you, it’s well worth taking painkillers in advance to keep you comfortable during the day. The same is true with back pain.

In summary I prefer people to use painkillers in a way that allows them to live with less pain and keep doing the things they enjoy, rather than not using medications that can help, suffering with pain and doing less.

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