Long-term effects of painkillers and analgesia
Analgesia (painkillers) are useful in the short term to deal with pain. If possible, long term use is best avoided, for the following reasons.
1. Opioid dependence and withdrawal
Long-term use of opioids (e.g. morphine, fentanyl) can lead to physical dependence. Withdrawal symptoms include nausea, tremors, and anxiety.
2. Gastrointestinal risks
Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and diclofenac increase the risk of gastrointestinal bleeding, ulcers, and perforation.
3. Cardiovascular risks
Long-term NSAID use may be associated with increased cardiovascular events (e.g. myocardial infarction, stroke) due to blood pressure elevation and fluid retention.
4. Renal impairment
Prolonged NSAID use can cause nephrotoxicity, leading to chronic kidney disease (CKD) and acute kidney injury (AKI).
5. Hepatotoxicity
Paracetamol (acetaminophen) overdose is a common cause of acute liver failure. Chronic use of >2g/day increases liver damage risk.
6. Cognitive impairment
Long-term opioid use may impair cognitive function, particularly memory and attention.
7. Endocrine effects
Opioids can disrupt endocrine function, leading to hypogonadism, adrenal insufficiency, and thyroid dysfunction.
8. Immunosuppression
Chronic opioid exposure weakens immune response, increasing infection risk.
9. Mood disorders
Long-term opioid use is linked to depression, anxiety, and mood swings.
10. Increased risk of falls
Opioids and NSAIDs can impair balance and increase fall risk, particularly in elderly patients.
Additional recommendations
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Prescription guidance: Follow NHS/NICE guidelines for pain management.
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Monitoring: Regularly assess patients for potential side effects.
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Alternative therapies: Consider non-pharmacological approaches (e.g. physical therapy, cognitive-behavioral therapy).
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Patient education: Inform patients about potential risks and benefits.
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Multidisciplinary care: Refer to pain management clinics.
Other resources
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NHS Guidelines: Pain Management
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NICE Guidelines: Chronic Pain Management
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British Journal of Clinical Pharmacology: Analgesic-related adverse effects
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The Lancet: Long-term opioid therapy
