"Why don't you take the painkillers?". Early in the morning, my wife saw Lao Wang holding his waist and looking in pain, and asked him worriedly and doubtfully.
"No, I don't want to eat too much! I heard a lot of people say that if you take too much painkillers, you will become addicted! Just hurt a little bit. I don't want to become an 'addict' who can't live without the medicine." "That's so scary!" Lao Wang shook his head, but an even more severe pain hit him immediately. Lao Wang bent over under the impact of pain, like a hunched-back prawn.
He couldn't help shouting: "It hurts too much, it hurts too much! Pour me half a glass of water. I'll just take half a tablet to relieve the pain first."
Regarding the phrase "addicted to taking too many painkillers", it's not just Lao Wang, but many People agree very much. Therefore, when they need to take painkillers for pain relief, they often resist and are unwilling to take them.
But when being tortured by unbearable pain like Lao Wang, everyone can only choose to take painkillers for relief, which is very contradictory.
If we want to solve this contradiction, we have to explore together: Will taking too much painkillers really make you addicted?
Why do people become addicted to certain substances?
First, we need to understand what "addiction" is. What we commonly call "addiction" is called "addiction mechanism" in medicine. There are many kinds of addiction mechanisms. Drug-related addiction mechanisms are actually controlled by the "reward system" in the brain.
The reward system was first recognized in 1954, which was the famous mouse brain stimulation experiment in psychology. Experiments have found that after electrical stimulation of a mouse's brain makes the mouse feel happy, the mouse will press the button at all costs to obtain the electrical stimulation.
Later, people gradually realized that various areas in the brain are interconnected to form a complex system, which produces reward-related behaviors and emotional responses.
In fact, the reward system plays a positive role. It mainly controls the secretion of dopamine . Dopamine is a well-known neurotransmitter , which is related to emotions such as pleasure and excitement. When a person is happy, the reward system sends out excitatory nerve messages, thereby releasing a certain amount of dopamine.
Normally, the dopamine released by the nerve impulses generated by emotions is quickly absorbed. When the absorption of dopamine is blocked due to factors such as drugs, too much dopamine stacks up and continuously stimulates neurons, resulting in a series of strong and short-lived stimulation .
This causes the brain's reward system to send out pleasant impulses, causing people to feel intense mental pleasure, and like experimental mice, they continue to obtain this pleasure at all costs.
Therefore, the reward effect of the mesolimbic system is the main cause of mental dependence and compulsive drug-seeking behavior , which is commonly known as drug addiction symptoms.
A common example in life is the desire to smoke. Nicotine, the main component in cigarettes, activates nerve cells in the limbic system of the midbrain, which contains dopamine. After nicotine enters the human body, it will secrete a large amount of dopamine, which will continue to produce a sense of pleasure in the brain, produce a reward effect, and ultimately lead to smoking addiction.
According to the definition of addiction by the American Society of Addiction Medicine, addiction has the following characteristics: is difficult to interrupt, behavioral self-control disorders, desire for drugs, weakening of interpersonal relationships, emotional disorders, etc. (Reference for the above content: The mesolimbic reward system is involved in the circuit mechanism of opioid addiction)
It can be seen from these characteristics that for people with less strong willpower, it is difficult to prevent the addiction mechanism once it is formed. Break . This is also the reason why drugs are hated by people - once they become addicted, withdrawal is extremely difficult to stop.
However, some people say that some painkillers can also produce a rewarding effect and lead to addiction. So what is going on?
Several common painkillers in clinical practice
If you want to know what addiction to painkillers is, you must first understand the painkillers and their pharmacological effects.
"Why don't you take the painkillers?". Early in the morning, my wife saw Lao Wang holding his waist and looking in pain, and asked him worriedly and doubtfully.
"No, I don't want to eat too much! I heard a lot of people say that if you take too much painkillers, you will become addicted! Just hurt a little bit. I don't want to become an 'addict' who can't live without the medicine." "That's so scary!" Lao Wang shook his head, but an even more severe pain hit him immediately. Lao Wang bent over under the impact of pain, like a hunched-back prawn.
He couldn't help shouting: "It hurts too much, it hurts too much! Pour me half a glass of water. I'll just take half a tablet to relieve the pain first."
Regarding the phrase "addicted to taking too many painkillers", it's not just Lao Wang, but many People agree very much. Therefore, when they need to take painkillers for pain relief, they often resist and are unwilling to take them.
But when being tortured by unbearable pain like Lao Wang, everyone can only choose to take painkillers for relief, which is very contradictory.
If we want to solve this contradiction, we have to explore together: Will taking too much painkillers really make you addicted?
Why do people become addicted to certain substances?
First, we need to understand what "addiction" is. What we commonly call "addiction" is called "addiction mechanism" in medicine. There are many kinds of addiction mechanisms. Drug-related addiction mechanisms are actually controlled by the "reward system" in the brain.
The reward system was first recognized in 1954, which was the famous mouse brain stimulation experiment in psychology. Experiments have found that after electrical stimulation of a mouse's brain makes the mouse feel happy, the mouse will press the button at all costs to obtain the electrical stimulation.
Later, people gradually realized that various areas in the brain are interconnected to form a complex system, which produces reward-related behaviors and emotional responses.
In fact, the reward system plays a positive role. It mainly controls the secretion of dopamine . Dopamine is a well-known neurotransmitter , which is related to emotions such as pleasure and excitement. When a person is happy, the reward system sends out excitatory nerve messages, thereby releasing a certain amount of dopamine.
Normally, the dopamine released by the nerve impulses generated by emotions is quickly absorbed. When the absorption of dopamine is blocked due to factors such as drugs, too much dopamine stacks up and continuously stimulates neurons, resulting in a series of strong and short-lived stimulation .
This causes the brain's reward system to send out pleasant impulses, causing people to feel intense mental pleasure, and like experimental mice, they continue to obtain this pleasure at all costs.
Therefore, the reward effect of the mesolimbic system is the main cause of mental dependence and compulsive drug-seeking behavior , which is commonly known as drug addiction symptoms.
A common example in life is the desire to smoke. Nicotine, the main component in cigarettes, activates nerve cells in the limbic system of the midbrain, which contains dopamine. After nicotine enters the human body, it will secrete a large amount of dopamine, which will continue to produce a sense of pleasure in the brain, produce a reward effect, and ultimately lead to smoking addiction.
According to the definition of addiction by the American Society of Addiction Medicine, addiction has the following characteristics: is difficult to interrupt, behavioral self-control disorders, desire for drugs, weakening of interpersonal relationships, emotional disorders, etc. (Reference for the above content: The mesolimbic reward system is involved in the circuit mechanism of opioid addiction)
It can be seen from these characteristics that for people with less strong willpower, it is difficult to prevent the addiction mechanism once it is formed. Break . This is also the reason why drugs are hated by people - once they become addicted, withdrawal is extremely difficult to stop.
However, some people say that some painkillers can also produce a rewarding effect and lead to addiction. So what is going on?
Several common painkillers in clinical practice
If you want to know what addiction to painkillers is, you must first understand the painkillers and their pharmacological effects.In fact, analgesics refers to a collection of drugs that can play an analgesic effect, and does not refer to any specific drug.
mentioned in the article "Current Status of Joint Application of Domestic Clinical Analgesics": The currently commonly used clinical analgesics are mainly three categories: non-steroidal (zaǐ) systemic anti-inflammatory drugs, opioid analgesics, gabapentin Drug .
Common nonsteroidal anti-inflammatory drugs include aspirin, ibuprofen, etc. This type of drug has anti-inflammatory and analgesic effects. It is often used clinically to relieve osteoarthritis, rheumatoid arthritis , various fevers and various pain symptoms. is the main treatment for inflammatory pain. Drug .
Among nonsteroidal anti-inflammatory drugs, although the chemical structures of various drugs are different, they all inhibit the synthesis of prostaglandin through to exert antipyretic, analgesic, and anti-inflammatory effects.
Prostaglandin is a hormone widely distributed in various tissues and body fluids of the body. It is metabolized very quickly in the body and participates in the body's defense system, such as participating in inflammatory reactions. So inflammation, fever, and pain may all be related to prostaglandins.
Therefore, nonsteroidal anti-inflammatory drugs mainly inhibit prostaglandin synthesis, thereby reducing pain. In other words, Taking NSAIDs is not likely to cause addiction.
Gabapentin is an anti-epileptic drug developed in recent years. This drug prevents epileptic seizures by changing neurotransmitter metabolism . Duloxetine (an antidepressant) has similar effects to gabapentin, which also acts as an antidepressant and even analgesic by inhibiting the uptake of neurotransmitters by neurons.
Because these drugs are involved in activities between nerves, some patients believe that long-term use of these drugs may lead to addiction. In fact, a large number of clinical research results have shown that drugs such as have a very weak inhibitory effect on dopamine reuptake compared with , which is equivalent to the relationship between well water and river water.
In addition, in vitro study results also show that drugs such as gabapentin and duloxetine have no obvious affinity with dopaminergic receptors. In other words, although they also affect the absorption of neurotransmitters, the target of this type of drug is not dopamine, and will not form a rewarding effect that leads to addiction .
And the final category of painkillers, opioid analgesics, is a seemingly dangerous agent.
In fact, another name for opium is the infamous opium, which is the extract of poppy. Opioid analgesics are divided into strong opioids and weak opioids based on their analgesic intensity. Strong opiates mainly include morphine, fentanyl, etc., which are mainly used to treat moderate and severe pain after surgery. Weak opiates include codeine, , tramadol, , etc., which are mainly used for acute and mild pain. or moderate pain analgesia.
In terms of pharmacological effects, opioid analgesics reduce the sensitivity of neurons by interacting with central-specific receptors, , thereby inhibiting pain transmission to relieve pain.
Some people may say that opioids accumulate dopamine by inhibiting neuronal tissue. Isn't it forming a reward effect? Isn't it the mechanism of addiction?
In fact, this is the inertial thinking caused by the fear of opioids. The use of opioids in clinical practice is very rigorous and scientific. . Here are some common misunderstandings about opioids.
Common misunderstandings about opioid analgesics
In fact, my country’s control over opioid analgesics is very strict. The article "Current Status of Joint Application of Domestic Clinical Analgesics" mentioned that opioid analgesics are not very effective for chronic pain, especially neuropathic pain, and are usually only used in patients with advanced cancer.
In addition, some people think that cancer patients who take opioid analgesics for a long time will inevitably become addicted, but this is actually wrong. In fact, long-term use of opioid analgesics to treat cancer pain, as long as the drugs are taken orally or using transdermal patches on time, the risk of addiction is extremely small.
Taking opioids in sustained-release dosage forms or transdermal administration on time can avoid excessive peak blood concentrations, thereby reducing the risk of addiction.
A similar statement is made that the use of opioids may require lifelong medication. This statement is actually wrong. After the cause of pain is controlled or eliminated, opioid analgesics can be stopped at any time and relatively safely, or switched to non-opioid analgesics.
In addition, some people say that non-opioid drugs are safer than opioids, but this statement is not scientific. For patients who need long-term painkillers, it is safer and more effective to use opioids. Long-term use of opioids will cause less damage to organs such as liver and kidneys. Therefore, when used correctly, opioids are safer than non-opioid medications.
There is also a saying that intravenous opioids are most effective. Opioids can take effect quickly when injected into the blood. This view seems reasonable, but it is actually wrong.
The World Health Organization proposed in the "Three-Step Analgesic Treatment Guidelines for Cancer Pain" that oral administration of opioids is the preferred route of administration . What determines the efficacy of an opioid is whether the drug concentration is equivalent to the receptor concentration. As long as the dose is the same, oral opioids are as effective as intravenous administration. Intravenous medication only takes a shorter time to take effect, but is prone to adverse reactions such as nausea and vomiting, and can also increase the patient's tolerance to morphine.
In addition, there is a kind of analgesic specially used for postoperative trauma. Its pharmacological effect is the same as that of opioids, but its addictiveness is much lower than that of opioids. The scientific name of this drug is pethidine. Some people think that pethidine should be used directly instead of opioids so that there is no risk of addiction. This argument is also untrue.
Different analgesics play different clinical roles. Clinical medicine pays attention to prescribing the right medicine, and no drug can be easily replaced. Pethidine mainly targets various types of severe pain, such as pain after traumatic surgery. The late-stage cancer pain of cancer patients cannot be relieved by using pethidine. In fact, the World Health Organization has listed pethidine as a drug not recommended for the treatment of cancer pain.
There are many reasons for this. For example, pethidine has poor oral absorption and utilization, so it is mostly administered by intramuscular injection. Intramuscular injections themselves are painful and are unevenly absorbed. At the same time, the analgesic intensity of pethidine is only 1/10 of morphine, and the elimination half-life of pethidine metabolites is long, and it has potential neurotoxicity and nephrotoxicity. Therefore, pethidine is not suitable for the treatment of chronic cancer pain or chronic non-cancer pain, and it cannot completely replace the opioid .
Conclusion:
In 1995, the International Association for the Study of Pain clearly stated that pain should be the fifth "vital sign" of humans after breathing, pulse, body temperature and blood pressure. In 2004, the World Health Organization designated October 11 of that year as the first "World Pain Relief Day". Pain seriously affects the quality of life of pain patients and makes them miserable.
Therefore, it is very important to treat pain actively and effectively, and should not be resistant to the use of analgesics. The use of analgesics is often scientific and cautious. As long as you follow the doctor's instructions and take the analgesics on time and in the right amount, it is unlikely to lead to addiction.
References:
[1] Sun Guolin, Zhang Yongmei. The circuit mechanism of the mesolimbic reward system involved in opioid addiction [J]. Chinese Pharmacological Bulletin, 2019, 35(05): 611-614.
[2 ] Zhou Wenzhe, Zhou Manhong. Current status of combined clinical analgesic application in China [J]. Chinese Journal of Critical Care Medicine (electronic version), 2016, 9(01): 54-57.
[3] Li Xiaoxiao, Deng Yanping. Addiction risk and evaluation of opioids in chronic pain control [J]. Chinese Journal of Drug Abuse Prevention and Control, 2013, 19(05): 271-274.
Taking opioids in sustained-release dosage forms or transdermal administration on time can avoid excessive peak blood concentrations, thereby reducing the risk of addiction.
A similar statement is made that the use of opioids may require lifelong medication. This statement is actually wrong. After the cause of pain is controlled or eliminated, opioid analgesics can be stopped at any time and relatively safely, or switched to non-opioid analgesics.
In addition, some people say that non-opioid drugs are safer than opioids, but this statement is not scientific. For patients who need long-term painkillers, it is safer and more effective to use opioids. Long-term use of opioids will cause less damage to organs such as liver and kidneys. Therefore, when used correctly, opioids are safer than non-opioid medications.
There is also a saying that intravenous opioids are most effective. Opioids can take effect quickly when injected into the blood. This view seems reasonable, but it is actually wrong.
The World Health Organization proposed in the "Three-Step Analgesic Treatment Guidelines for Cancer Pain" that oral administration of opioids is the preferred route of administration . What determines the efficacy of an opioid is whether the drug concentration is equivalent to the receptor concentration. As long as the dose is the same, oral opioids are as effective as intravenous administration. Intravenous medication only takes a shorter time to take effect, but is prone to adverse reactions such as nausea and vomiting, and can also increase the patient's tolerance to morphine.
In addition, there is a kind of analgesic specially used for postoperative trauma. Its pharmacological effect is the same as that of opioids, but its addictiveness is much lower than that of opioids. The scientific name of this drug is pethidine. Some people think that pethidine should be used directly instead of opioids so that there is no risk of addiction. This argument is also untrue.
Different analgesics play different clinical roles. Clinical medicine pays attention to prescribing the right medicine, and no drug can be easily replaced. Pethidine mainly targets various types of severe pain, such as pain after traumatic surgery. The late-stage cancer pain of cancer patients cannot be relieved by using pethidine. In fact, the World Health Organization has listed pethidine as a drug not recommended for the treatment of cancer pain.
There are many reasons for this. For example, pethidine has poor oral absorption and utilization, so it is mostly administered by intramuscular injection. Intramuscular injections themselves are painful and are unevenly absorbed. At the same time, the analgesic intensity of pethidine is only 1/10 of morphine, and the elimination half-life of pethidine metabolites is long, and it has potential neurotoxicity and nephrotoxicity. Therefore, pethidine is not suitable for the treatment of chronic cancer pain or chronic non-cancer pain, and it cannot completely replace the opioid .
Conclusion:
In 1995, the International Association for the Study of Pain clearly stated that pain should be the fifth "vital sign" of humans after breathing, pulse, body temperature and blood pressure. In 2004, the World Health Organization designated October 11 of that year as the first "World Pain Relief Day". Pain seriously affects the quality of life of pain patients and makes them miserable.
Therefore, it is very important to treat pain actively and effectively, and should not be resistant to the use of analgesics. The use of analgesics is often scientific and cautious. As long as you follow the doctor's instructions and take the analgesics on time and in the right amount, it is unlikely to lead to addiction.
References:
[1] Sun Guolin, Zhang Yongmei. The circuit mechanism of the mesolimbic reward system involved in opioid addiction [J]. Chinese Pharmacological Bulletin, 2019, 35(05): 611-614.
[2 ] Zhou Wenzhe, Zhou Manhong. Current status of combined clinical analgesic application in China [J]. Chinese Journal of Critical Care Medicine (electronic version), 2016, 9(01): 54-57.
[3] Li Xiaoxiao, Deng Yanping. Addiction risk and evaluation of opioids in chronic pain control [J]. Chinese Journal of Drug Abuse Prevention and Control, 2013, 19(05): 271-274.
