opioid

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Some opioids are made from the opium plant, and others are synthetic (man-made).

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Opioids can cause side effects such as drowsiness, mental fog, nausea, and constipation. They may also cause slowed breathing, which can lead to overdose deaths. If someone has signs of an overdose, call 911. These signs may include:

• Very small pupils of the eyes
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Vomiting
• Limp body
• Pale, blue, or cold skin
• Faint heartbeat
• Purple lips and fingernails

When using opioids, there is also a risk of opioid use disorder (OUD).

Opioid use disorder (OUD) means that you have a problematic pattern of using opioids. The pattern causes a lot of distress and impairment (meaning that it causes problems in and interferes with your daily life). Instead of OUD, sometimes people use the terms "opioid dependence" and "opioid addiction." Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm.

The risk of OUD is higher if you misuse the medicines. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's opioids.

Opioid use disorder and overdoses are serious public health problems in the United States. As more people misuse opioids, more women are misusing opioids during pregnancy. This can lead to health risks for the mother and baby. The baby may be born with neonatal abstinence syndrome (NAS). NAS is a group of withdrawal symptoms that a baby has after being exposed to drugs during pregnancy.

Another problem with increased opioid misuse is that it can also lead to more heroin use. There are some people who switch from prescription opioids to heroin because heroin may be cheaper and easier to get.

There are effective medicines to treat OUD. Using medicines to treat OUD is called medications for opioid use disorder (MOUD). MOUD can help you stop using the drug, get through withdrawal, and cope with cravings. It is often combined with behavioral therapy and counseling. Having support from family and friends can also help.

There is also a medicine called naloxone which can treat opioid overdoses. It can reverse the effects of the overdose and prevent death if it is given quickly.

To prevent problems with prescription opioids, be sure to follow your doctor's instructions when taking them. Do not share your medicines with anyone else. Contact your doctor if you have any concerns about taking the medicines.

NIH: National Institute on Drug Abuse

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, opioid use disorder (OUD) is still a possible risk.

Opioid use disorder (OUD) means that you have a problematic pattern of using opioids. The pattern causes a lot of distress and impairment (meaning that it causes problems in and interferes with your daily life). Instead of OUD, sometimes people use the terms "opioid dependence" and "opioid addiction." Dependence means feeling withdrawal symptoms when not taking the drug. Addiction is a chronic brain disease that causes a person to compulsively seek out drugs, even though they cause harm.

Treatments for OUD include:

• Medicines; this kind of treatment is known as medications for opioid use disorder (MOUD)
• Counseling and behavioral therapies
• Residential and hospital-based treatment

The medicines used in MOUD are methadone, buprenorphine, and naltrexone:

• Methadone, buprenorphine, and lofexidine, which can decrease withdrawal symptoms and cravings. They work by acting on one or another of the targets in the brain that opioids act on. But these medicines are different because they do not make you feel high. Some people worry that if they take methadone or buprenorphine, it means that they are substituting one addiction for another. But it is not; these medicines are a treatment. They restore balance to the parts of the brain affected by addiction. This allows your brain to heal while you work toward recovery.

  You may safely take these medicines for months, years, or even a lifetime. If you want to stop taking them, do not do it on your own. You should contact your provider first, and together you can work out a plan for stopping.

• Naltrexone works differently than methadone and buprenorphine. It does not help you with withdrawal symptoms or cravings. Instead, it takes away the high that you would normally get when you take opioids. Because of this, you would take naltrexone to prevent a relapse, not to try to get off opioids. You have to be off opioids for at least 7-10 days before you can take naltrexone. Otherwise you could have bad withdrawal symptoms.

• A combination drug that includes buprenorphine and naloxone. Naloxone is a drug to treat an opioid overdose. If you take it along with buprenorphine, you will be less likely to misuse the buprenorphine.

Counseling for OUD can help you:

• Change your attitudes and behaviors related to drug use
• Build healthy life skills
• Stick with other forms of treatment, such as medicines

There are different types of counseling for OUD, including:

• Individual counseling, which may include setting goals, talking about setbacks, and celebrating progress. You may also talk about legal concerns and family problems. Counseling often includes specific behavioral therapies, such as
• Cognitive-behavioral therapy (CBT), which helps you recognize and stop negative patterns of thinking and behavior. It teaches you coping skills, including how to manage stress and change the thoughts that cause you to want to misuse opioids.
• Motivational enhancement therapy, which helps you build up motivation to stick with your treatment plan.
• Contingency management, which focuses on giving you incentives for positive behaviors such as staying off the opioids.
• Group counseling, which can help you feel that you are not alone with your issues. You get a chance to hear about the difficulties and successes of others who have the same challenges. This can help you learn new strategies for dealing with the situations you may come across.
• Family counseling, which includes partners or spouses and other family members who are close to you. It can help to repair and improve your family relationships.

Counselors can also refer you to other resources that you might need, such as:

• Peer support groups, including 12-step programs like Narcotics Anonymous
• Spiritual and faith-based groups
• HIV testing and hepatitis screening
• Case or care management
• Employment or educational supports
• Organizations that help you find housing or transportation

Residential programs combine housing and treatment services. You are living with your peers, and you can support each other to stay in recovery. Inpatient hospital-based programs combine health care and OUD treatment services for people with medical problems. Hospitals may also offer intensive outpatient treatment. All these types of treatments are very structured, and usually include several different kinds of counseling and behavioral therapies. They usually also include MOUD.

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when these medicines are misused. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's opioids.

Opioids affect the part of the brain that regulates breathing. When people take high doses of opioids, it can lead to an overdose, with the slowing or stopping of breathing and sometimes death.

An opioid overdose can happen for a variety of reasons, including if you:

• Take an opioid to get high.
• Take an extra dose of a prescription opioid or take it too often (either accidentally or on purpose).
• Mix an opioid with other medicines, illegal drugs, or alcohol. An overdose can be fatal when mixing an opioid and certain anxiety treatment medicines, such as Xanax or Valium.
• Take an opioid medicine that was prescribed for someone else. Children are especially at risk of an accidental overdose if they take medicine not intended for them.

There is also a risk of overdose if you are getting medications for opioid use disorder (MOUD). MOUD is a treatment for OUD. Many of the medicines used for MOUD are also controlled substances that can be misused.

Anyone who takes an opioid can be at risk of an overdose, but you are at higher risk if you:

• Take illegal opioids
• Take more opioid medicine than you are prescribed
• Combine opioids with other medicines and/or alcohol
• Have certain medical conditions, such as sleep apnea, or reduced kidney or liver function
• Are over 65 years old

The signs of an opioid overdose include:

• Very small pupils of the eyes
• Falling asleep or loss of consciousness
• Slow, shallow breathing
• Choking or gurgling sounds
• Vomiting
• Limp body
• Pale, blue, or cold skin
• Faint heartbeat
• Purple lips and fingernails

If you think someone is having an opioid overdose:

• Call 911 immediately.
• Give the person naloxone, if it is available. Naloxone is a safe medication that can quickly stop an opioid overdose. There are two forms. One is a nasal spray that you spray info the nose. The other type is injected into the muscle under the skin, or into the veins. Naloxone works by blocking the effects of the opioids on the body. It's important to read the product instructions and check the expiration date before you give it to someone.
• Try to keep the person awake and breathing.
• Lay the person on their side to prevent choking.
• Stay with the person until emergency workers arrive.

Naloxone won't harm someone if they're overdosing on drugs other than opioids, so it's best to use it if you think someone is overdosing.

If you are taking opioid pain medicine, there are steps you can take to help prevent an opioid overdose:

• Take your medicine exactly as prescribed by your provider. Do not take more medicine at once or take medicine more often than you are supposed to.
• Never mix the pain medicines with alcohol, sleeping pills, or illegal substances.
• Store your medicine safely where children or pets can't reach it. Consider using a medicine lockbox. Besides keeping children safe, it also prevents someone who lives with you or visits your house from stealing your medicines.
• Dispose of unused medicine promptly.

It is also important to teach your family and friends how to respond to an overdose. If you are at higher risk of an overdose, you will want get naloxone and carry it with you wherever you go. You can buy naloxone at a pharmacy.

You may need to take medicines while you are pregnant. But not all medicines are safe during pregnancy. Many medicines carry risks for you, your baby, or both. Opioids, especially when misused, can cause problems for you and your baby while you are pregnant.

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when these medicines are misused. Misuse can include taking your opioid medicines in greater amounts or more often than you are supposed to, using them to get high, or taking someone else's opioids.

Taking opioids during pregnancy can cause problems for you and your baby. The possible risks include:

• Neonatal abstinence syndrome (NAS) - withdrawal symptoms such as irritability, seizures, vomiting, diarrhea, fever, and poor feeding in newborns
• Neural tube defects - birth defects of the brain, spine, or spinal cord
• Congenital heart defects - problems with the structure of the baby's heart
• Gastroschisis - a birth defect of the baby's abdomen, where the intestines stick outside of the body through a hole beside the belly button
• Loss of the baby, either miscarriage (before 20 weeks of pregnancy) or stillbirth (after 20 or more weeks)
• Preterm delivery - a birth before 37 completed weeks of pregnancy
• Stunted growth, leading to low birthweight
• Problems with the placenta (the organ that brings oxygen and nutrients to the baby)

If your provider suggests that you take opioids during pregnancy, you should first discuss the risks and benefits. Then if you both decide that you need to take the opioids, you should work together to try to minimize the risks. Some of the ways to do this include:

• Taking them for the shortest time possible
• Taking the lowest dose that will help you
• Carefully following your provider's instructions for taking the medicines
• Contacting your provider if you have side effects
• Going to all your follow-up appointments

If you have been taking opioids and you become pregnant, contact your provider. But don't stop taking the opioids on your own. If you suddenly stop taking opioids, it could cause severe health problems for you or your baby. In some cases, stopping suddenly during pregnancy may be more harmful than taking the medicines.

If you regularly take opioid medicines, you may be able to breastfeed. It depends on which medicine you are taking. But you should not breastfeed if you have HIV or take illegal drugs. Check with your provider before breastfeeding.

If you are pregnant and have an opioid use disorder, do not stop taking opioids suddenly. Instead, see your provider so you can get help. The treatment for opioid use disorder (OUD) is called medication for opioid use disorder (MOUD). For MOUD during pregnancy, providers prescribe either buprenorphine or methadone. These medicines can reduce your cravings and help prevent withdrawal.

Counseling, including behavioral therapies, can also help you to change your attitudes and behaviors related to drug use and build healthy life skills.

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your provider. However, people who take opioids are at risk for opioid use disorder (OUD) and overdose. These risks increase when opioids are misused. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's opioids.

First, you need to talk with your provider about whether you need to take opioids. You should discuss:

• Whether there are other medicines or therapies that might treat your pain
• The risks and benefits of taking opioids
• Your medical history and if you or anyone in your family has a history of substance misuse, a drug addiction, or alcohol use disorder (AUD)
• Any other medicines and supplements you are taking
• How much alcohol you drink
• If you are pregnant or planning to become pregnant

If you and your provider decide that you need to take opioids, make sure that you understand:

• How to take the medicine - how much and how often.
• How long you will need to take the medicine.
• What the possible side effects are.
• How you should stop the medicines when you no longer need them. If you have been taking opioids for a while, it can be dangerous to just stop suddenly. You may need to get off the medicines slowly.
• What the warning signs of addiction are, so you can watch for them. They include:
• Regularly taking more medicine than you are supposed to
• Taking someone else's opioids
• Taking the medicine to get high
• Mood swings, depression, and/or anxiety
• Needing too much or too little sleep
• Trouble making decisions
• Feeling high or sedated

If you have a high risk for an overdose, you will want to get naloxone from a pharmacy and carry it with with you wherever you go. Naloxone is a medicine that can reverse the effects of an opioid overdose.

You should always be careful when taking any medicine, but you need to take extra care when taking opioids:

• Take your medicine exactly as prescribed - do not take extra doses.
• Check the instructions every time you take a dose.
• Do not break, chew, crush, or dissolve opioid pills.
• Opioids can cause drowsiness. Do not drive or use any machinery that may injure you, especially when you first start the medicine.
• Contact your provider if you have side effects.
• If you can, use the same pharmacy for all your medicines. The pharmacy's computer system will alert the pharmacist if you are taking two or more medicines that could cause a dangerous interaction.

It is important to store and dispose of opioid medicines properly:

• Store your opioids and other medicines in a safe place. If you have children at home, it's a good idea to store your medicines in a lockbox. Even one accidental dose of an opioid pain medicine meant for an adult can cause a fatal overdose in a child. Also, someone who lives with you or visits your house may look for and steal your opioid medicines to take or sell them.
• If you travel, carry the current bottle of opioids with you for safety. This will help you answer any questions about your medicine.
• Dispose of your unused medicine properly. If you have unused opioid medicines at the end of your treatment, you can get rid of them by:
• Finding a local drug take-back program
• Finding a pharmacy mail-back program
• In some cases, flushing them down the toilet - check the Food and Drug Administration (FDA) web site to find out which ones you can flush away
• Never sell or share your medicines. Your prescription is for you. Your health care provider considers many factors when prescribing opioids. What's safe for you might lead to an overdose for someone else.
• If someone steals your opioid medicines or prescription, report the theft to the police.

During pregnancy, there are many things you can do to keep yourself and your baby healthy. They include getting regular prenatal care, eating healthy, and staying active. But it's also very important to avoid substances that could be harmful to you and your baby, such as tobacco, alcohol, and drugs.

Tobacco

Smoking during pregnancy passes nicotine, carbon monoxide, and many other harmful chemicals to your baby. Nicotine is not only a health danger for you, but it can also damage your developing baby's brain and lungs. Carbon monoxide can keep the developing baby from getting enough oxygen.

If you smoke while pregnant, it raises the risk of your baby being born too small, too early, or with birth defects. During the first year of life, there is a higher risk of your baby dying from sudden infant death syndrome (SIDS). And later in life, your child may be more likely to have health problems, such as asthma and obesity.

Other tobacco products, including e-cigarettes, also contain nicotine and are not safe to use during pregnancy. And some of the flavorings used in e-cigarettes may be harmful to developing babies.

You will also want to try to avoid secondhand smoke, which has some of the same risks as smoking during pregnancy.

Alcohol

There is no known amount of alcohol that is safe for you to drink during pregnancy and while trying to get pregnant. All types of alcohol are equally harmful, including all wines and beer. The risks from drinking during pregnancy include problems with the growth of the developing baby and fetal alcohol spectrum disorders (FASD). FASD is a life-long condition that can cause a mix of physical, behavioral, and learning problems.

Illegal drugs

Using illegal drugs, such as cocaine, methamphetamines, and club drugs, during pregnancy can cause problems for both you and your baby. They may cause low birth weight babies, birth defects, or miscarriage. Your child may be more likely to have learning and developmental disabilities. And if you are injecting the drugs, that puts you at risk for HIV. HIV can be passed along to your baby during pregnancy.

Prescription drug misuse

Misusing prescription drugs can also be harmful. Misuse can include taking more than your prescribed dose or taking it more often, using it to get high, or taking someone else's medicines. The possible effects of misusing a medicine during pregnancy will depend on which medicine you are misusing.

Opioids

One type of drug that is a concern during pregnancy is opioids. Opioids include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid. Taking opioids during pregnancy can cause problems for you and your baby. The risks include birth defects, preterm birth, the loss of the baby, and neonatal abstinence syndrome (NAS). NAS causes withdrawal symptoms in newborn babies.

If you have pain and your health care provider suggests that you take prescription opioids during pregnancy, first discuss the risks and benefits with the provider. Then if you both decide that you need to take the opioids, you can work together to try to minimize the risks.

Cannabis (marijuana)

Getting help

If you are taking opioids or are addicted to drugs, don't stop taking them suddenly. That can be dangerous to you and the baby. Instead, contact your provider for help with getting off the drugs safely.

Heroin is an illegal, very addictive opioid drug. It's made from morphine, which comes from the seedpod of opium poppy plants. These plants grow in Southeast and Southwest Asia, Mexico, and Colombia. Heroin can be a white or brown powder, or a black sticky substance known as black tar heroin.

People inject, sniff, snort, or smoke heroin. Some people mix heroin with crack cocaine, which is called "speedballing." All these ways of taking heroin send it to the brain very quickly, which makes it highly addictive.

People who use heroin report feeling a "rush" (a surge of pleasure). And then they may feel other effects, such as a warm flushing of the skin, dry mouth, and a heavy feeling in the arms and legs. They may also have severe itching, nausea, and vomiting. After these first effects, they will usually be drowsy for several hours, and their breathing will slow down.

People who use heroin over the long term may develop many different health problems. These problems could include liver, kidney, and lung disease, mental disorders, and abscesses.

People who inject the drug also risk getting infectious diseases such as HIV, hepatitis, and bacterial infections of the skin, bloodstream, and heart (endocarditis). They can also get collapsed veins. When a vein collapses, the blood cannot flow through it.

Repeated use of heroin can lead to tolerance. This means users need more and more of the drug to have the same effect. At higher doses over time, the body becomes dependent on heroin. If someone who is dependent on heroin stops using it, they have withdrawal symptoms. These symptoms can include restlessness, muscle and bone pain, diarrhea, vomiting, and cold flashes with goose bumps.

Repeated use of heroin often leads to heroin use disorder, sometimes called addiction. This is more than physical dependence. It's a chronic (long-lasting) brain disorder. When someone has it, they continue to use heroin even though it causes problems in their life. Some examples include health problems and not being able to meet responsibilities at work, school, or home. Getting and using heroin becomes their main purpose in life.

It's possible to overdose on heroin. This happens when a person uses so much heroin that it causes a life-threatening reaction or death. All heroin users are at risk of an overdose because they never know the actual strength of the drug they are taking or what may have been added to it. And people often use heroin along with other drugs or alcohol. This can increase the risk of an overdose.

When people overdose on heroin, their heart rate and breathing slow down. Their breathing may slow do so much that not enough oxygen reaches the brain. This condition is called hypoxia. Hypoxia can lead to a coma, permanent brain damage, or death.

A medicine called naloxone can treat a heroin (or other opioid) overdose if it is given in time. It works by blocking the effects of the opioid on the body. Sometimes more than one dose of the medicine is needed.

There are two forms of naloxone that anyone can use without medical training: nasal spray and injectable. People at risk of an overdose are encouraged to carry naloxone with them. They can buy naloxone at a pharmacy.

Treatments for heroin use disorder include medicines to treat withdrawal symptoms, medicine to block the effects of opioids, and behavioral treatments. Often, a combination of medicine and behavioral treatment works best. People getting treatment for heroin use disorder should work with their health care providers to come up with a treatment plan that fits their needs.

NIH: National Institute on Drug Abuse

Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen, chest, pelvis, or you may feel pain all over.

There are two types of pain:

• Acute pain usually comes on suddenly, because of a disease, injury, or inflammation. It can often be diagnosed and treated. It usually goes away, though sometimes it can turn into chronic pain.
• Chronic pain lasts for a long time, and can cause severe problems

Pain relievers are medicines that reduce or relieve pain. There are many different pain medicines, and each one has advantages and risks. Some are over-the-counter (OTC) medicines. Others are stronger medicines, which are available by prescription. The most powerful prescription pain relievers are opioids. They are very effective, but people who take them are at risk of addiction and overdose.

Because of the side effects and risks of pain relievers, you may want to try non-drug treatments first. And if you do need to take medicines, also doing some non-drug treatments may allow you to take a lower dose.

There are many non-drug treatments that can help with pain. It is important to check with your health care provider before trying any of them:

• Acupuncture involves stimulating acupuncture points. These are specific points on your body. There are different acupuncture methods. The most common one involves inserting thin needles through the skin. Others include using pressure, electrical stimulation, and heat. Acupuncture is based on the belief that qi (vital energy) flows through the body along paths, called meridians. Practitioners believe that stimulating the acupuncture points can rebalance the qi. Research suggests that acupuncture can help manage certain pain conditions.
• Biofeedback techniques use electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them. For example, a biofeedback device may show you measurements of your muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them. Biofeedback may help to control pain, including chronic headaches and back pain.
• Electrical stimulation involves using a device to send a gentle electric current to your nerves or muscles. This can help treat pain by interrupting or blocking the pain signals. Types include
• Transcutaneous electrical stimulation (TENS)
• Implanted electric nerve stimulation
• Deep brain or spinal cord stimulation
• Massage therapy is a treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Among other benefits, it may help people relax, and relieve stress and pain.
• Meditation is a mind-body practice in which you focus your attention on something, such as an object, word, phrase, or breathing. This helps you to minimize distracting or stressful thoughts or feelings.
• Physical therapy uses techniques such as heat, cold, exercise, massage, and manipulation. It can help to control pain, as well as condition muscles and restore strength.
• Psychotherapy (talk therapy) uses methods such as discussion, listening, and counseling to treat mental and behavioral disorders. It can also help people who have pain, especially chronic pain, by
• Teaching them coping skills, to be able to better deal with the stress that pain can cause
• Addressing negative thoughts and emotions that can make pain worse
• Providing them with support
• Relaxation therapy can help reduce muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It may be used with guided imagery (focusing the mind on positive images) and meditation.
• Surgery can sometimes be necessary to treat severe pain, especially when it is caused by back problems or serious musculoskeletal injuries. There are always risks to getting surgery, and it does not always work to treat pain. So it is important to go through all of the risks and benefits with your health care provider.

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There are many different pain medicines, and each one has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.

Over-the-counter (OTC) medicines are good for many types of pain. There are two main types of OTC pain medicines: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) are examples of OTC NSAIDs.

If OTC medicines don't relieve your pain, your doctor may prescribe something stronger. Many NSAIDs are also available at higher prescription doses. The most powerful pain relievers are opioids. They are very effective, but they can sometimes have serious side effects. There is also a risk of opioids. Because of the risks, you must use them only under a doctor's supervision.

There are many things you can do to help ease pain. Pain relievers are just one part of a pain treatment plan.

Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.

There are three types of delirium:

• Hypoactive, when you are not active and seem sleepy, tired, or depressed
• Hyperactive, when you are restless or agitated
• Mixed, when you change back and forth between being hypoactive and hyperactive

There are many different problems that can cause delirium. Some of the more common causes include:

• Advanced cancer.
• Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol use disorder (AUD).
• Dehydration and electrolyte imbalances.
• Dementia.
• Hospitalization, especially in intensive care.
• Infections, such as urinary tract infections, pneumonia, and the flu.
• Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be from withdrawal after stopping a medicine.
• Metabolic disorders.
• Organ failure, such as kidney or liver failure.
• Poisoning.
• Serious illnesses.
• Severe pain.
• Sleep deprivation.
• Surgeries, including reactions to anesthesia.

Certain factors put you at risk for delirium, including:

• Being in a hospital or nursing home
• Having dementia
• Having a serious illness or more than one illness
• Having an infection
• Older age
• Having surgery
• Taking medicines that affect the mind or behavior
• Taking high doses of pain medicines, such as opioids

The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include:

• Changes in alertness (usually more alert in the morning, less at night)
• Changing levels of consciousness
• Confusion
• Disorganized thinking, talking in a way that doesn't make sense
• Disrupted sleep patterns, sleepiness
• Emotional changes: anger, agitation, depression, irritability, overexcitement
• Hallucinations and delusions
• Memory problems, especially with short-term memory
• Trouble concentrating

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• Physical and neurological exams
• Mental status testing, which checks for problems with your thinking and alertness
• Lab and diagnostic imaging tests

Delirium and dementia have similar symptoms, so it can be hard to tell them apart. You can also have both at the same time. The differences between them are that:

• Delirium starts suddenly and can cause hallucinations. It is mainly a problem with attention and staying alert. The symptoms may get better or worse and can last for hours or weeks.
• Dementia develops slowly and does not cause hallucinations. It usually starts with memory loss. The symptoms don't change often, like they can with delirium. Dementia almost never gets better.

Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as:

• Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around
• Medicines, including those that control aggression or agitation and pain relievers if there is pain
• If needed, making sure that the person has a hearing aid, glasses, or other devices for communication

Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that hospital rooms are kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person each day (if possible).