Effects and risks of psychotropic and analgesic combinations.

Psychotropic substances combined with simple analgesics are a common pharmacologic denominator in the dependency complex. More than 95 percent of patients studied took preparations containing barbiturates; the remaining few subjects used analgesics combined with caffeine. Dependence on compound analgesic preparations usually develops in patients with headaches--migraine, tension headaches, and other complex forms--since ergotamine-containing preparations are generally effective only at the onset of an attack, and prophylactic administration is, therefore, common. Once dependence has developed, reduction or discontinuation of the medication is typically followed after one or two days by an increase in the intensity of the pain. This may cause the patient to revert to these preparations in an attempt to reduce pain and may lead to an unfortunate vicious cycle. Therefore, cessation of psychotropic analgesic combinations is essential in the treatment of chronic pain.