This article explains how dependence on pain killers can develop, which warning signs of medication misuse to look out for, and how to reduce opioid painkillers safely, limiting withdrawal symptoms, with medical support.
Some pain killers, especially opioid painkillers such as codeine, co-codamol and tramadol, can lead to dependence when taken regularly for a long time. According to the NHS, the body can become used to opioid painkillers, so higher doses of medication are needed for the same pain relief, and stopping pain killers suddenly can cause withdrawal symptoms. Dependence on pain killers can develop even with a prescription, so any change to medication should be planned with a doctor.
Key takeaways
1. Opioid painkillers such as codeine, co-codamol and tramadol can cause tolerance, dependence, withdrawal symptoms and, for some people, addiction.
2. Co-codamol bought from a pharmacy should not be used for more than 3 days without speaking to a pharmacist or doctor.
3. An important warning sign of dependence is taking pain killers to prevent pain before the pain appears, rather than in response to it.
4. Stopping opioid painkillers suddenly can cause substance withdrawal symptoms such as anxiety, panic attacks and difficulty sleeping.
5. Good pain management for long-term pain usually involves more than medication: guidance recommends exercise programmes and psychological therapy for chronic primary pain.
What Are Pain Killers?
Pain killers, also called painkillers or pain relief medication, are medication used to reduce pain. Some pain killers, such as paracetamol, ibuprofen and aspirin, can be bought from a pharmacy or shop. Stronger pain killers, such as codeine and tramadol, are opioid painkillers and usually need a prescription.
Co-codamol is a medication that combines paracetamol with codeine, which makes co-codamol one of the opioid painkillers associated with dependence. Low-strength co-codamol can be bought from a pharmacy, while higher strengths need a prescription. According to the NHS, co-codamol bought from a pharmacy should not be used for more than 3 days, and if pain has not gone away, the next step is to talk to a pharmacist or doctor.
Which Pain Killers Can Cause Dependence?
Opioid painkillers carry the clearest risk of dependence and withdrawal symptoms. UK clinical guidance on prescription medication associated with dependence (NICE NG215) lists opioid painkillers, particularly when taken long term for pain not related to cancer, among the main groups of medication associated with dependence or withdrawal symptoms. The guidance notes evidence linking higher long-term doses of opioid painkillers with a greater risk of addiction.
Gabapentin and pregabalin, prescription medication often used for nerve pain, are also listed as medication associated with dependence and withdrawal symptoms. Chronic pain guidance (NICE NG193) describes pregabalin and gabapentin as controlled substances and advises prescribers to watch for signs of medication misuse and dependence.
Everyday pain killers such as paracetamol and ibuprofen do not cause dependence in the same way as opioid painkillers, but regular overuse of medication can still cause harm. Headache guidance (NICE CG150) describes medication overuse headache, a headache that develops or worsens when pain killers are taken too often for 3 months or more.
Can You Become Addicted to Pain Killers?
Yes. The NHS states that it is possible to become addicted to opioid painkillers, including codeine, the codeine in co-codamol, and tramadol. If co-codamol is taken regularly for a long time, dependence and addiction to the codeine in the medication can develop. Addiction is less likely when people follow their doctor's advice on pain killers carefully.
Long-term use of opioid painkillers can lead to tolerance and dependence: according to the NHS, the body becomes used to the medication, so higher doses of medication are needed to control pain over time. Tolerance is one of the two features of dependence; the other is withdrawal symptoms. Some people also become more sensitive to pain, a condition called hyperalgesia, and a doctor will then reduce the dose of medication gradually.
Dependence on pain killers is not the same as addiction. Dependence describes tolerance and withdrawal symptoms; addiction adds cravings, loss of control and continuing medication despite harm. Our article The Difference Between Dependence and Addiction (https://www.noveya.co.uk/blog/the-difference-between-dependence-and-addiction) explains the difference between dependence and addiction in more detail.
What Are the Warning Signs of Dependence on Pain Killers?
The warning signs of dependence on pain killers and medication misuse are often quiet at first. NHS advice on opioid painkillers and UK guidance on medication associated with dependence point to warning signs such as:
1. Needing a higher dose of medication for the same pain relief.
2. Feeling the need to take pain killers more often than necessary.
3. Finding it difficult to stop taking opioid painkillers.
4. Running out of a prescription for medication earlier than expected, or seeking an early prescription.
5. Getting a prescription for opioid painkillers from more than one prescriber.
6. Continuing pain killers despite harm, such as drowsiness or confusion.
7. Pain or headaches getting worse despite regular pain killers.
None of these warning signs on its own proves medication misuse or addiction. Together, the warning signs are a good reason to talk to a GP or pharmacist about pain killers and dependence.
Lived Experience at NOVEYA: When Pain Killers Are Taken Out of Fear of Pain
Barbara Zadworna, Founder of NOVEYA, shares her own experience of pain killers and dependence:
"From my own experience, I know how easy it is to believe that a pain killer cannot do any harm, because a pain killer is there to help. There was a time when I combined strong medication just so I would not feel pain. Over time, I started taking pain killers even before the pain had really appeared, more out of fear of the pain than in response to it."
"At that time, I did not notice that I was dulled, that I was thinking more slowly and that I was no longer functioning the way I used to. All my attention was focused on one thing: that it must not hurt."
Why Is "I Have to Take It Before the Pain Comes" a Warning Sign?
"Today, I think an important warning sign is the moment we stop asking 'do I need this medication right now?' and start thinking 'I have to take it so the pain does not come'," says Barbara. "Admitting to yourself that the line between controlling pain and needing the medication has started to blur can be hard. But that is exactly the moment to talk to a doctor or another specialist, instead of trying to cope with it alone."
Taking pain killers in advance can also affect pain itself. The NHS notes that long-term use of opioid painkillers can make some people more sensitive to pain, and headache guidance (NICE CG150) warns that taking opioid painkillers or combination pain killers on 10 or more days a month, or paracetamol, aspirin or ibuprofen-type medication on 15 or more days a month, for 3 months or more can lead to medication overuse headache.
What Are the Withdrawal Symptoms of Opioid Painkillers?
Withdrawal symptoms from opioid painkillers are the physical and mental reactions that can appear when pain killers are reduced or stopped. According to the NHS, substance withdrawal symptoms after stopping opioid painkillers such as codeine or tramadol can include:
1. Feeling agitated or anxious.
2. Panic attacks.
3. Palpitations (feeling your heartbeat).
4. Difficulty sleeping.
5. Shaking and sweating.
6. Body aches and feeling restless.
Withdrawal symptoms from prescription medication associated with dependence do not affect everyone. According to NICE guidance (NG215), it is not possible to predict who will be affected, and where withdrawal symptoms do appear, withdrawal symptoms can vary widely in type and severity and affect both physical and mental health.
When Do Withdrawal Symptoms Start and How Long Do They Last?
Withdrawal symptoms can begin during a reduction of medication or later, and withdrawal symptoms can sometimes last a long time. Withdrawal symptoms can also be hard to tell apart from the return of the original pain, as body aches are one of the withdrawal symptoms of opioid painkillers. Any new or worsening pain during a reduction of pain killers should be discussed with a healthcare professional.
How Can You Reduce Opioid Painkillers Safely?
Reducing opioid painkillers safely when dependence has developed means lowering the dose of medication gradually, with a plan agreed with a prescriber, to limit withdrawal symptoms. These steps reflect NHS and NICE guidance:
Step 1: Do not stop opioid painkillers suddenly on your own, as stopping suddenly can bring on withdrawal symptoms. The NHS warns that stopping codeine suddenly can cause withdrawal symptoms such as feeling agitated or anxious, and that a doctor will gradually reduce the dose over several weeks or months.
Step 2: Talk to your GP or pharmacist. Guidance on medication associated with dependence recommends that any reduction of prescription medication is agreed through shared decision-making, and that a reduction plan can be slowed down if withdrawal symptoms become hard to cope with.
Step 3: Review your pain management plan. For chronic primary pain, NICE guidance (NG193) recommends a supervised group exercise programme and suggests psychological therapy, such as cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT), and advises against starting opioid painkillers for chronic primary pain.
Step 4: Avoid alcohol. The NHS warns that drinking alcohol with co-codamol or tramadol can make people more sleepy and increase the risk of serious side effects of opioid painkillers.
Step 5: Bring support. People can ask a family member or someone close to them to come to medical appointments about medication, dependence and withdrawal symptoms.
What the Guidance Says
Pain killers can cause dependence: NHS guidance states that it is possible to become addicted to opioid painkillers such as codeine and tramadol, that long-term use of opioid painkillers can lead to tolerance, and that codeine should not be stopped suddenly because stopping suddenly can cause withdrawal symptoms.
In Short
Pain killers help with pain, but opioid painkillers such as codeine, co-codamol and tramadol can lead to tolerance, dependence, withdrawal symptoms and addiction, even with a prescription. A clear warning sign of dependence on pain killers is taking pain killers to prevent pain rather than to treat pain. If you are worried about pain killers, talk to a GP or pharmacist, and do not stop opioid painkillers suddenly, as stopping suddenly can cause withdrawal symptoms.
Our article Prescription Drug Addiction: When Medication Becomes a Problem (https://www.noveya.co.uk/blog/prescription-drug-addiction) looks at other types of prescription medication associated with dependence, and our article Sleeping Tablets and Dependence: Recognising the Warning Signs (https://www.noveya.co.uk/blog/sleeping-tablets-and-dependence) looks at dependence on sleep medication.
At NOVEYA, understanding comes first, support follows, and change becomes possible once support is there.
Frequently Asked Questions
Is it safe to take pain killers every day?
Taking pain killers every day should be discussed with a GP or pharmacist. Headache guidance (NICE CG150) warns that regular pain killers on 10 to 15 or more days a month for 3 months or more can cause medication overuse headache, and opioid painkillers taken long term can lead to dependence and withdrawal symptoms.
How long can I take co-codamol bought from a pharmacy?
According to the NHS, co-codamol bought from a pharmacy should not be used for more than 3 days. If pain has not gone away after 3 days, talk to a pharmacist or doctor about pain management.
Can I drink alcohol with pain killers like codeine?
The NHS advises avoiding alcohol during the first few days of co-codamol or tramadol treatment, because alcohol can make people more sleepy and increase the risk of serious side effects of opioid painkillers.
Can pain killers make pain worse?
Yes, in some cases. The NHS notes that long-term use of opioid painkillers can make some people more sensitive to pain (hyperalgesia), and overuse of pain killers can cause medication overuse headache.
Are withdrawal symptoms from pain killers dangerous?
Withdrawal symptoms from opioid painkillers, such as anxiety, panic attacks and difficulty sleeping, can be very hard to cope with, which is why the dose of medication should be reduced gradually with a doctor. Any severe or worsening withdrawal symptoms should be discussed with a healthcare professional.
What should I do if I have taken too many pain killers?
Taking an extra dose of opioid painkillers such as codeine can be dangerous. The NHS advises calling NHS 111 if you have taken more than your prescribed dose. If you are told to go to A&E, do not drive: ask someone to drive you or call 999 for an ambulance.
About This Article
Barbara Zadworna is the Founder of NOVEYA, bringing together a Bachelor's degree in Psychology and Criminology, professional experience supporting people in a psychiatric hospital setting, specialist training in Addiction Therapy and Psychological First Aid (2026), and personal lived experience of addiction and recovery.
If you would like to talk to someone or find out more about the support NOVEYA offers, get in touch (support@noveya.co.uk).
Sources
NHS guidance on codeine.
NHS guidance on co-codamol for adults.
NHS guidance on tramadol.
NICE (2022) Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults (NG215).
NICE (2021) Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193).
NICE (2012) Headaches in over 12s: diagnosis and management (CG150).