Painkillers: Tolerance vs. Addiction
Needing a higher dose of painkillers to manage your pain does not mean you're addicted. But it's important to be able to distinguish between addiction and tolerance.
Chronic pain can be a serious threat to your well-being — but painkillers, which are prescribed to improve the quality of life for people with pain, present a different kind of threat: Addiction and overdose.
Should you be worried about becoming addicted to your painkillers? Your first step is knowing the difference between painkiller tolerance and addiction.
What Is Painkiller Tolerance?
People who use opioid painkillers for months or years often develop a tolerance to the drugs — which means they need higher doses of the medication to achieve the same results.
Many people who take painkillers worry about their risk of addiction and see signs of tolerance as the early hint of a downward spiral, but this is not necessarily an accurate, says Wilson Compton, MD, MPE, division director of the division of epidemiology, services, and prevention research at the National Institute of Drug Abuse at the National Institutes of Health. “The question of the difference between tolerance and addiction gets at how we define addiction and how we distinguish appropriate medical use.”
Certain patients are at increased risk of addiction to prescription medications — especially those who have had substance abuse problems in the past. But most people can avoid addiction when they're taking painkillers.
“Tolerance is an absolutely normal expected phenomenon when people take many pharmacological substances on a regular basis. As your body adjusts, you need more of a dose to get the effect you’re looking for,” explains Compton. Your body, primarily your liver, starts to process the medication more efficiently while your brain requires more of the medication to achieve the same effects. “If you need a painkiller for months or years, the dose that was adequate at the beginning might be five- or ten-fold less than what you will need after those months or years,” he adds.
Is It Tolerance or Addiction?
Understanding the difference between tolerance and addiction is crucial.For example, if you find that the same dose of painkillers that helped you three months ago isn’t quite easing the pain this month, you should contact your doctor to figure out whether you need a higher dose and, if so, how much.
Addiction, on the other hand, leads to less rational behaviors. For example, a person developing an addiction might start to argue with himself, day after day, telling himself that taking an extra dose “because of a hard day” is okay without calling the doctor. “Where people get into trouble is when they start to self-medicate,” he says. A classic sign of addiction from the doctor’s perspective is when a person whose pain is under control asks for more painkillers. Doctors have various ways of determining whether pain is under control or not beyond a patient’s self report, cautions Compton.
“Addiction is when we organize our lives around a substance and continue it despite it causing problems, or when we use more than we plan or intend to,” says Compton.
Addressing the Problem of Pain Medication Tolerance
Compton emphasizes that working closely with your doctor is key to getting the right dose of a painkiller. He also says it’s a good idea to ask your doctor or nurse about when you can take an extra dose to help manage your pain. While not a good idea on a regular basis, there may be times, such as after a day of traveling or being physically active, when an extra dose is okay — you just need to make sure you and your doctor are on the same page about this decision.
Finally, it's important for people taking painkillers to know that tolerance will keep building as long as you are taking the medication, but if you stop for some time, it will begin to fade. This can be a problem for patients, says Compton, who often try to restart at the same high dose they were taking when they stopped and find that the higher dose of painkiller is too much for their system. If you stop taking painkillers for a period of time and feel that you may need to start again, check in with your doctor first.