Are you addicted to painkillers?

Over-the-counter (OTC) painkillers provide an easy way to treat short-term aches and pains. But use them too often and you may develop a dependency - even if you stay within the recommended daily dosage.

'Prolonged use of some over-the-counter painkillers, such as those containing codeine, may become addictive if taken more regularly than recommended,' says Nitin Makadia, pain expert at Lloyds Pharmacy. 'Painkiller addiction happens when the body builds up a tolerance to a prescribed dose of medicine meaning that a higher dose needs to be taken to have the same effect.'

What are the symptoms?
Excessive use of OTC painkillers can lead to a number of psychological symptoms. 'These are often manifested in extreme mood swings, irritability and withdrawal issues,' says Raymond Dixon, lead addictions therapist at Capio Nightingale Hospital. 'And while many people are familiar with the addictive nature of codeine, the paracetamol content of these medicines is often overlooked when, in reality, it's as much of a concern. Paracetamol takes longer to leave the system and can build up over time, with a number of physical consequences, including liver damage.'

It's also important to be aware of the caffeine content in these products - particularly if you also drink caffeinated drinks, such as cola and coffee. Some painkiller brands contain particularly high levels of caffeine, which is in itself highly addictive. Caffeine acts as a stimulant to the heart and central nervous system, and increases blood pressure in the short term. So pop a high-caffeine pill and you could be putting a strain on your heart, too.

But I'm in pain...
Of course, short-term use of painkillers to treat a headache or period pain won't do you any harm. Indeed, it may well the best course of action. But if the pain hasn't gone within a day or two, the medication clearly hasn't done its job - in which case, you should ask the advice of a GP or pharmacist rather than continuing to pop the pills. 'All codeine-based painkillers must carry a warning, much like cigarettes, advising against use for more than three consecutive days,' points out Raymond Dixon. Feel the need to take them for any longer than that and it doesn't mean you're an instant addict - but it does mean they're not doing their job if you're still in pain. So why continue taking them?

What's more, continual painkiller use may actually make headaches worse because our brains become 'immune' to the drugs' effects, according to a recent report by the National Institute For Health and Clinical Excellence (NICE). Around one million UK headache sufferers are thought to suffer from 'medication overuse headaches', having become over-reliant on OTC painkillers.

What are the alternatives?
Before you pop a painkiller, it's important to stop and ask yourself why you're doing it. 'Be honest with yourself: are you really in that much pain?' asks Michael Garnham, head of therapy at TTP Harley Street. 'Or are you taking it because you think you might be in pain later on? Or simply to put an extra spring in your step? Busy women sometimes take painkillers to make up for a deficiency elsewhere in their lives - such as lack or sleep or poor diet. This isn't what these pills are designed for. If you're taking them to get through the day, you need to stop and address the core issue.'

And even if you are in pain, OTC medication almost definitely isn't the only way to beat it. Some alternatives? If you suffer from regular chronic headaches and migraine, acupuncture may hold the key. Recent NICE recommendations state that GPs should consider offering a course up to 10 sessions of acupuncture for the preventative treatment of these types of headaches. Consult your GP for your information - or contact the British Acupuncture Council.

Believe it or not, it may also be the case that you're simply dehydrated. Sipping around seven glasses of water throughout the day can be enough to ease pain for regular headache sufferers, according to recent research from the University of Maastricht.

Topical treatments, such as Deep Relief - which can be bought in pharmacies nationwide - can also be highly effective in treating long-term muscle and joint pain.

I may be addicted - now what?
'Anyone who is concerned they might be addicted to, or developing a dependency on, over-the-counter painkillers really must seek professional help,' insists Raymond Dixon. 'Excessive use of these products isn't something that can be stopped "dead" and there will be a period of withdrawal that will have both psychological and physiological consequences."

And, as Michael Garnham points out, acknowledging your misuse of painkillers is often just the first step towards addressing the real issues that are affecting your life. 'You need to work out what really needs fixing,' he says. 'Are you depressed? Overwhelmed? Coping with a particular challenge? Remember, addiction often masks the true problem.'

For further information about pain control, speak to your GP or a pharmacist. You can also download a free leaflet about how to manage OTC medication from www.pagb.co.uk and www.britishpainsociety.org.