Why Painkillers Stop Working Over Time: An Orthopedic Surgeon Explains

Dr. Mayur Rabhadiya, an orthopedic surgeon, explains how repeated use of painkillers can lead to tolerance, increased sensitivity, and unresolved joint issues over time.

Painkillers are among the most commonly used medicines for knee pain, back pain, neck pain, and other musculoskeletal problems. Many patients tell me the same thing during consultations:“Doctor, pehle painkiller kaam karti thi. Ab effect hi nahi hota.”

This experience is real, common, and medically explainable.

In this article, I will explain why painkillers stop working over time, what actually happens inside the body, and why repeated painkiller use may sometimes worsen pain instead of relieving it. More importantly, we will discuss what should be done when pain keeps returning despite medication.

Why Painkillers Stop Working Over Time and What They Actually Do

To understand why painkillers stop working over time, it is important to understand what painkillers are designed to do and what they are not designed to do.

Painkillers do not treat the root cause of pain. They work by blocking or modifying pain signals traveling from the affected area to the brain.

Commonly used painkillers include:

• Paracetamol

• NSAIDs like ibuprofen and diclofenac

• Combination analgesics

These medicines can be very effective for short-term pain relief, especially after injury, surgery, or acute inflammation. However, they do not correct problems like cartilage damage, ligament injury, disc degeneration, or joint arthritis.

When the underlying cause remains untreated, pain tends to return.

Why Painkillers Stop Working Over Time Due to Tolerance

One of the main reasons why painkillers stop working over time is a phenomenon called drug tolerance.

When the same painkiller is used repeatedly:

• The nervous system adapts to the medicine

• Pain receptors become less responsive

• The same dose produces less relief

This is not weakness or imagination. It is a normal biological response.

As tolerance develops, patients often notice:

• Pain relief does not last as long

• Higher doses are required for the same effect

• Switching brands gives only temporary benefit

Increasing the dose without medical supervision is risky and does not solve the real problem.

Why Painkillers Stop Working Over Time in Chronic Pain Conditions

The issue of why painkillers stop working over time is especially relevant in chronic conditions such as:

• Knee osteoarthritis

• Chronic back pain

• Cervical spondylosis

• Shoulder tendon problems

In chronic pain, the nervous system itself becomes sensitized. Pain is no longer only about tissue damage. The brain and nerves start amplifying pain signals.

This is why patients with long-standing pain often say: “The pain feels worse than before, even though scans look similar.”

Painkillers are not designed to reset this sensitization.

Why Painkillers Stop Working Over Time and Can Increase Pain Sensitivity

A lesser-known but important reason why painkillers stop working over time is something called pain sensitization.

With long-term or frequent painkiller use:

• The nervous system may become over-alert

• Pain thresholds can reduce

• Smaller stimuli can feel more painful

This means pain may feel stronger even when the physical problem has not significantly worsened.

Clinically, this is why some patients report:

• Pain spreading to nearby areas

• Pain lasting longer than expected

• Reduced response to medications that once worked

This does not mean painkillers are bad. It means they are being used beyond their intended role.

Why Painkillers Stop Working Over Time in Knee Pain and Arthritis

Knee pain is one of the most common reasons patients rely on long-term painkillers.

In knee osteoarthritis:

• Cartilage gradually wears out

• Joint mechanics change

• Muscles around the knee weaken

Painkillers may reduce pain temporarily, but they do not:

• Restore cartilage

• Improve joint alignment

• Strengthen muscles

This explains why painkillers stop working over time in knee arthritis. Without addressing biomechanics, muscle strength, weight management, and joint health, pain relief remains temporary.

Why Painkillers Stop Working Over Time in Back and Neck Pain

Back pain and neck pain often have multiple contributors:

• Disc degeneration

• Muscle imbalance

• Poor posture

• Nerve irritation

Painkillers may help during acute flare-ups. However, when used as the primary long-term strategy, they fail to correct the mechanical and postural causes.

This is another reason why painkillers stop working over time in spine-related conditions.

Long-term improvement usually requires:

• Targeted physiotherapy

• Postural correction

• Core strengthening

• Activity modification

Why Painkillers Stop Working Over Time and Why Increasing the Dose Is Not the Answer

A common assumption is that increasing the dose or changing medicines will restore relief. In reality, this often worsens the problem.

Increasing painkiller use can lead to:

• Faster tolerance

• Gastrointestinal side effects

• Kidney or liver strain

• Masking of worsening joint or nerve damage

From an orthopedic perspective, escalating medication without re-evaluation delays proper diagnosis and treatment.

This is why understanding why painkillers stop working over time is critical for safe long-term care.

Why Painkillers Stop Working Over Time and What Should Be Done Instead

If pain keeps returning despite medication, the focus should shift from pain suppression to cause identification.

This includes:

• Detailed clinical examination

• Appropriate imaging when needed

• Functional assessment of joints and muscles

• Understanding lifestyle and activity patterns

Depending on the condition, treatment may include:

• Structured physiotherapy

• Weight optimization

• Injection-based treatments when indicated

• Activity modification

• Surgical options only when clearly necessary

Painkillers then become a supportive tool, not the main treatment.

Why Painkillers Stop Working Over Time: When Painkillers Are Still Useful

It is important to clarify that painkillers still have a role.

They are appropriate for:

• Acute injuries

• Post-operative pain

• Short-term flare-ups

• Temporary symptom control during rehabilitation

Problems arise only when painkillers become the sole long-term strategy for chronic pain.

Used judiciously and under medical guidance, they remain safe and effective.

Why Painkillers Stop Working Over Time: Key Takeaways for Patients

To summarize:

• Painkillers block pain signals but do not treat the cause

• Repeated use leads to tolerance

• Long-term use can increase pain sensitivity

• Chronic pain needs a structured treatment approach

• Escalating doses without evaluation is unsafe

Understanding why painkillers stop working over time empowers patients to seek the right care at the right time.

About the Author

Dr. Mayur Rabhadiya

Orthopedic & Joint Replacement Surgeon

MBBS, D’Ortho, DNB (Orthopedics), M.N.A.M.S ( Ortho.)

Fellowship in Robotic & Computer-Navigated Joint Replacement

Dr. Mayur Rabhadiya specializes in evidence-based orthopedic care, knee and hip replacement surgery, and non-surgical management of chronic joint and spine conditions.

📍 Practicing at Ghatkopar East & West, Mumbai

🌐 Website: www.mayurajcc.com📞 Appointments: 8424903913 | 9611330063

Medical Disclaimer

This article is for educational purposes only and does not replace medical consultation. Diagnosis and treatment decisions should be made after proper clinical evaluation by a qualified doctor.