Analgesic nephropathy occurs most commonly in Australia, where it is the second most frequent cause of renal failure. Whilst the reasons for widespread abuse of analgesics are poorly understood, the consequences of abuse are now well recognised. Increasing emphasis is being placed on the analgesic syndrome and on the accelerated atherosclerosis seen in these patients. Attention in the article is drawn to ways in which the analgesic syndrome can be recognised and analgesic abuse ceased. A therapeutic approach is presented which allows the successful withdrawal of analgesic in almost all patients.