Pain and addiction: recognizing the risks of pain medication 

Pain is one of the most common reasons people seek medical care. Whether it’s after surgery, an injury, or managing a chronic condition, the goal is often simple: feel better and get back to daily life without discomfort. Prescription medications, especially opioids, are sometimes part of that treatment. But whether you’re in recovery from opioid use disorder (OUD) or are someone who’s never taken anything stronger than aspirin, understanding the risks that come with certain medications is important.

The past few decades have been a wake-up call. As opioid prescriptions climbed, so did addiction rates and overdose deaths. The CDC reports that more than 76% of drug overdose deaths in America involve opioids. While only a portion of those come from prescription drugs, it was doctor-prescribed opioids that led to the first wave of the opioid crisis.

OUD doesn’t stem from a character flaw or lack of willpower. It’s a complex, chronic condition that can develop for a variety of reasons, including genetics, mental health, environment, and past trauma.  Even so, addiction is a health condition that could affect anyone under certain circumstances. That’s why it’s important to look at pain management through a lens of compassion and awareness.

We’ll walk you through which medications carry the highest risk, how dependency can happen, and what safer options are out there. And if you still have questions, just book a visit with your QuickMD provider. We’re here to support your recovery and your overall well-being.

Which pain medications carry the highest risk of addiction?

Not all pain medications work the same way, and some come with a much higher risk for addiction. Let’s look at why certain medications can lead to dependency.

Opioids: the highest risk

Opioids are strong pain relievers that carry the highest risk for addiction among prescription drugs.  Doctors typically prescribe these to patients for severe post-surgical pain or serious injuries like fractures. They include medications like:

• Oxycodone (OxyContin, Percocet)
• Hydrocodone (Vicodin)
• Morphine
• Fentanyl
• Codeine
  

So, why are opioids so addictive? These drugs work by binding to opioid receptors in your brain and spinal cord. They block pain while triggering a release of dopamine (AKA, the “feel-good” chemical).

That dopamine surge can create a strong sense of relief and even euphoria. Your brain starts to connect the medication with comfort and safety. Over time, this reward cycle can become harder to shake, even if you’re taking the medication exactly as prescribed. 

The body also builds a tolerance quickly. That means you might need higher doses to feel the same effect, which increases the risk of dependence. This is not a personal or moral failing. It’s a chemical reaction to how your brain and body naturally respond to relief. 

Withdrawal from opioids is tough. Nausea, muscle aches, anxiety, and cravings can set in quickly after you stop. It’s no wonder many people find themselves in a cycle they didn’t see coming. 

Even a short prescription can carry risk. Studies show that taking opioids for more than five days can increase the likelihood of long-term use.

Benzodiazepines and muscle relaxers: a risky combo 

Benzodiazepines (sometimes called “benzos”) are medications often prescribed for anxiety, sleep issues, or seizures. Some common prescription brand names you might recognize include:

• Xanax (alprazolam)
• Valium (diazepam)
• Klonopin (clonazepam)
  

On the flipside, muscle relaxers like Soma (carisoprodol) or Flexeril (cyclobenzaprine) are used for muscle spasms or tension. 

While both benzos and muscle relaxers aren’t opioids, they can still cause dependency and have a potentially deadly effect, especially when mixed with other medications. You’ll sometimes see them in prescription medication regimens alongside opioids to help people manage anxiety disorders and muscle pain. 

These substances slow down the central nervous system. When taken together with opioids, they can significantly increase the risk of overdose. In fact, the FDA even issued a Boxed Warning, its strongest safety warning,  about this combination because it can lead to dangerous breathing suppression, sedation, and fatal respiratory arrest.

Mixing medications can happen accidentally. For instance, a person might have two different doctors, such as a therapist and a pain specialist. Both doctors might not know what the other is prescribing. If you’re using both prescribed benzodiazepines and opioids together, just one prescription overlap from two different doctors can increase overdose risk by up to 20%.

Over-the-counter pain relievers: safer, but not risk-free 

Over-the-counter medications are often the first line of defense for mild to moderate pain. 

These non-prescription medications include:

• Acetaminophen (Tylenol)
• Ibuprofen (Advil)
• Naproxen (Aleve)
  

These medications don’t carry the same risk of dependency because they don’t activate the brain’s reward system in the same way opioids do. However, that doesn’t mean they’re risk-free. 

Acetaminophen, for example, can be found in everything from cold medicine to headache tablets. When taken in high doses or over long periods, it can damage the liver. 

Similarly, nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen and naproxen may irritate the stomach or affect kidney function if used frequently.

That’s why it’s important to follow dosage guidelines and talk to your provider about any pain that isn’t improving.

What are the long-term side effects of prescription medication use?

While pain relief may be the short-term goal, long-term use of certain medications can lead to a number of physical and mental health challenges.

Let’s look at what can happen when medications are taken beyond the intended timeframe or without a proper tapering plan.

Nervous system impairment: what to watch for

Opioids and benzodiazepines slow down the central nervous system. This means they can reduce breathing and heart rate, especially when combined with alcohol or other sedatives.

Synthetic opioids like fentanyl are extremely potent. Overdose can happen quickly, and signs include shallow breathing, blue or pale skin, pinpoint pupils, and unresponsiveness.

Naloxone (Narcan) can reverse an opioid overdose if given in time. If you suspect an overdose, call 911 immediately and use naloxone if available.

Organ failure: liver and kidney damage

Your liver and kidneys are your body’s detox team. When you take multiple medications, even over-the-counter ones, these organs work overtime.

Even common medications like acetaminophen (found in reliable mainstays like Tylenol and other products) need some attention to dosage. Taking more than the recommended amount (generally, about 4,000mg daily, or 8 tablets) can affect your liver health over time.

Something many of us don’t realize is how the same ingredients can appear in different products. For example, that nighttime cold medicine to help you sleep might contain the same acetaminophen that’s in your regular pain reliever. 

Checking medication labels and talking to your provider or pharmacist can help you avoid accidentally doubling up on ingredients and answer any questions about how different medications might overlap.

Cognitive effects: memory and focus problems

Long-term use of opioids or benzodiazepines can affect concentration, memory, and mood. You might notice brain fog, forgetfulness, or difficulty focusing. These symptoms can also worsen during withdrawal if medications are stopped too quickly.

If you’re worried about these side effects, your QuickMD provider can help you explore treatment options.  Recognizing the cognitive risks of prescription drug dependency can help you take steps to protect your brain health.

Mental health challenges: depression and anxiety

Many people taking opioids or benzos long-term report increased feelings of anxiety or depression. That’s because these medications can interfere with your brain’s natural ability to regulate mood. Research also suggests a link between long-term opioid use and suicidal thoughts. 

If you’re struggling with mental health symptoms, talk to your provider. You’re not alone, and support is there for you. Here at QuickMD, we offer counseling to support your recovery, with access to licensed counselors for only $19 per session, with no insurance required. No matter what you’re dealing with on your path to recovery, it’s helpful to have someone who understands and listens without judgment. 

Safer alternatives to opioids for pain management

Managing pain doesn’t have to mean risking dependency. Let’s look at some evidence-based options that many people find helpful. 

Non-opioid pain medications

There are both over-the-counter (OTC) and prescription medications that can help manage pain that aren’t opioids. Some examples include:

• Acetaminophen (Tylenol)
• NSAIDs like ibuprofen and naproxen
• Gabapentin and pregabalin (found in prescription medications like Lyrica) for nerve pain
  

These medications work in different ways. Acetaminophen and NSAIDs reduce inflammation, while gabapentin and pregabalin calm overactive nerve signals. They’re especially helpful for chronic conditions like arthritis, diabetic neuropathy, or post-surgical nerve pain.

Always follow dosage instructions carefully since taking too much acetaminophen can cause liver damage, and using NSAIDsfor too long could lead to stomach ulcers and kidney problems down the road. 

Topical pain relievers

For localized pain (like that achy knee or stiff lower back), creams and patches can offer targeted relief. 

• Lidocaine numbs pain at the skin’s surface
• Capsaicin (made from hot peppers!) reduces pain signal chemicals
• Biofreeze and Voltaren gels are over-the-counter NSAIDs in gel form
  

These options limit whole-body side effects while providing relief right where you need it. 

Physical therapy and exercise

Gentle movement might feel like the last thing you want when you’re in pain, but building strength and improving mobility can make a big difference over time. A physical therapist can design a plan to help you regain strength safely with exercises to help strengthen the muscles around those painful areas, improve flexibility, and correct posture or movement patterns that might be making your pain worse.

If you’re just starting out with exercise or physical therapy, be patient with yourself. A 10-minute daily walk often provides more lasting benefits than an occasional intense gym session. And if you deal with constant joint pain, water-based exercises at your local YMCA or community pool can be a great way to reduce weight-bearing stress while building strength.

Mind-body techniques

Pain and stress are closely connected. That’s why mind-body techniques can be surprisingly effective for managing chronic pain, including:

• Meditation
• Deep breathing
• Guided imagery
• Cognitive Behavioral Therapy (CBT)
  

CBT, a form of talk therapy, can help you identify and restructure your thought patterns that intensify pain experiences. When you catch yourself thinking “This knee pain will never end” or “I can’t play basketball anymore,” CBT provides some techniques to tame these thoughts and replace them with more helpful ones.

Meditation apps like Headspace and Calm now feature specific pain management programs designed by clinical psychologists. Calm’s “Pain Relief” section has some good options to check out. These digital tools make timeless practices accessible through your smartphone. 

At QuickMD, we know that living with pain while navigating recovery can feel overwhelming at times. That’s why we provide non-judgmental, personalized support to help you manage both safely.