Avoiding addiction
These pills won't kill when taken properly

MICHAEL Jackson went through it. So did other stars such as Heath Ledger and Kelly Osbourne.

The latest celebrity battling a painkiller addiction is Aerosmith's Steven Tyler. The rock singer, who suffers from chronic pain resulting from performance injuries, reportedly checked into a rehab centre last month to seek help for his addiction to prescription painkillers.

Prescription painkillers, which work by blocking pain pathways in the body, have been making headlines for the wrong reasons in recent months.

About 8.7 per cent of Singaporeans suffer from chronic pain, based on findings from a local survey by The Pain Association of Singapore.

Last year, the Singapore General Hospital (SGH) Pain Management Centre saw 6,000 of such chronic pain sufferers, a 25 per cent increase from the previous year.

Most of them suffer from crippling back and neck aches, diabetic nerve pain, post-surgical pain and cancer pain, according SGH Pain Management Centre director Dr Tan Kian Hian, who will be speaking about pain management at a public forum at the end of the month (see box).

In many cases, prescription painkillers are one of the first lines of treatment for chronic pain sufferers.

If you're one of those who consume multiple painkillers to deal with your chronic pain, what are your chances of unwittingly becoming addicted to them?

Unlikely to develop addiction if taken properly

According to Dr Tan, it is "very unlikely" that a normal person develops an addiction to painkillers prescribed by a doctor. This is even if the person suffers from chronic pain and pops painkillers regularly.

"The addiction cases that were reported in the news were likely to have been abusing their prescription painkillers to derive a sense of psychological well-being," said Dr Tan.

Plus, not all types of painkillers are potentially addictive, he added.

Associate Professor Munidasa Winslow, a specialist in psychiatry at Raffles Hospital, said that most people get addicted to the opioid group of painkillers, which includes morphine, subutex, codeine, tramadol and methadone. Codeine can be found in cough mixtures.

"Most of the time, they seek the euphoric feeling with the use of this group of painkillers."

Like any other forms of addiction, a painkiller addiction usually starts gradually, added Assoc Prof Winslow, whose clinical interest includes addiction problems.

"The substance provides some relief and some pleasurable feelings, or it helps numb unpleasant feelings and sensations," he said.

On the other hand, painkillers such as nerve pain medication or anti-inflammatory painkillers are not addictive, said Dr Tan.

This also includes over the counter painkillers such as paracetamol, which Assoc Prof Winslow added has little psychoactive effects other than relieving headaches and so there would be "little inclination to take more and more of them".

That said, Assoc Prof Winslow said patients need to be aware of the addictive potential of the painkillers they are taking. Painkiller overdose can be fatal. When consumed in high doses, most narcotic painkillers can suppress the brain centre responsible for breathing, he said.

"Ask your doctor if you find that you have an increased need for the medication, or if you are always looking forward to taking it," Assoc Prof Winslow advised.

He added that patients can also consider other adjunctive medications and therapies that can be used to manage pain (see box).

However, those taking stronger painkillers, such as morphine-based ones used to manage conditions like cancer pain, would need to stick to their doctor's medical advice strictly, said Dr Tan.