How do tolerance, physical dependence and addiction differ?

It's easy to confuse addiction with tolerance and physical dependence. But these are three distinct conditions.

• Tolerance. Sometimes your body adapts to the ongoing presence of a drug. The initial dosage of a medication becomes less effective over time. You may need higher doses of the medication to achieve the same level of pain relief. This is called tolerance. It's normal — and not a sign of addiction. In some cases, tolerance can even be helpful. Side effects may disappear when your body becomes more used to the medication.
• Physical dependence. When your body has adapted to the presence of a drug, you may experience withdrawal symptoms if you abruptly stop taking the drug. This is physical dependence. Many types of nonaddictive drugs — including corticosteroids and beta blockers — can cause physical dependence. If you gradually decrease the dosage under your doctor's direction, you can stop taking these medications without experiencing withdrawal symptoms.
• Addiction. Addiction is a disease. If you're addicted to a drug, you'll use the drug despite serious or harmful consequences to your body, your relationships, your career or other parts of your life. You may not be able to recognize the situation yourself. Although addiction and physical dependence often occur together, you can have addiction without physical dependence. Likewise, you can have physical dependence without addiction.

Which pain medications are most addictive?

Opioids — sometimes called narcotics — are among the most addictive pain medications. Commonly prescribed opioids include:

• Codeine
• Fentanyl (Duragesic, others)
• Hydrocodone (Vicodin, Lortab, others)
• Hydromorphone (Dilaudid, others)
• Meperidine (Demerol, others)
• Morphine (MS Contin, Kadian, others)
• Oxycodone (OxyContin, Percocet, others)
• Propoxyphene (Darvon, others)

Who's at risk?

The tendency to develop an addiction seems to be inherited. If you have family members who abuse drugs or alcohol, you have a higher risk of the same problem. Anxiety, depression and loneliness also increase the risk. Past problems with substance abuse play a role as well. For example, a history of alcoholism increases the risk of problems with prescription pain medications — even if you're in recovery.

But most people who take pain medication only as directed never become addicted — even during long-term use. The key is to take the medication exactly as prescribed by your doctor. Ask your doctor for printed instructions. Understand possible side effects and interactions with other drugs.

What are the warning signs?

Medication addiction can develop very subtly. Look for these warning signs:

• You take more pain medication than your doctor has prescribed.
• You request prescriptions from multiple doctors.
• You use alcohol or other medications to increase the effects of the pain medication.
• You take pain medication to deal with other problems, such as anxiety or stress.
• Your doctor, friends or loved ones express concern about your use of pain medication.

If you're worried about medication addiction, be honest with your doctor. Share your concerns, including any personal or family history of substance abuse or addiction. Your doctor needs this information to choose the type of pain medication that will work best for you.

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FDA: Don't overdo pain pills

		Time release: Pain relievers shouldn't be taken longer than 10 days, according to the FDA.

That's the message the Food and Drug Administration is trying to get out to consumers. If you think you need to take naproxen, ibuprofen or aspirin — all nonsteroidal anti-inflammatory drugs, or NSAIDs — for longer than 10 days, do so under a doctor's supervision, the agency is now advising. And don't take any more pills a day than the label, or your doctor, recommends.

If your doctor has prescribed Celebrex or Bextra, two newer NSAIDs known as COX-2 inhibitors, you and your doctor should discuss whether you really need to take the drugs, according to a just-released health advisory from the FDA.

If you're at risk for a heart attack or stroke but not for digestive tract bleeding, you probably should stick with an older NSAID. Theoretically, the COX-2 inhibitors are less likely to cause digestive tract bleeding, but Pfizer, maker of Celebrex and Bextra, has not yet been able to convince the FDA that it should be able to make that claim on the drugs' labels.

"We have held the COX-2s to a very high standard to get an indication (label claim) for reduced gastrointestinal bleeding," says John Jenkins, director of the FDA's Office of New Drugs.

At a news conference Friday, Jenkins called the public health advisory "an interim measure, pending further review of data that continue to be collected."

In recent weeks, studies comparing Celebrex, Bextra, Vioxx and naproxen — an older NSAID sold over-the-counter as Aleve — with a placebo have shown that they could increase the risk of heart attack and stroke, especially if taken for long periods or by people who are at high risk for such problems. Merck pulled its COX-2 inhibitor, Vioxx, off the market Sept. 30, but Celebrex and Bextra remain.

Though aspirin has been shown to reduce the risk of heart attack or stroke in people who already have had one, it also is among the NSAIDs most likely to cause a stomach ulcer, Jenkins said.

In light of the new information about risks of heart attack and stroke, Jenkins said, the FDA is requiring that researchers re-evaluate all prevention studies — in which healthy people are given a drug to see whether it prevents a disease or condition — involving Celebrex or Bextra.

That's not good enough, says consumer advocate Sidney Wolfe, director of Public Citizen's Health Research Group. Wolfe has called for the FDA to ban Celebrex and Bextra.

"The FDA is once again siding with a large pharmaceutical company," he says.

Pfizer, maker of Celebrex and Bextra, says a planned FDA advisory committee meeting on COX-2 inhibitors in February "is the appropriate forum for a thorough review of all available data."

Meanwhile, the company said Friday in a statement that "patients should continue to consult their doctor to ensure they get the pain treatment appropriate for their individual medical need."

EASING THE PAIN

Aren't you tired of consistently having to medicate yourself to receive any relief?