Narcotic Drugs for the Treatment of Chronic Pain: A Double Edged Sword

In recent years, the prevalence of of narcotic pain killers—also called opioids—has increased exponentially, and so has the number of deaths related to use of these medications.

In particular, narcotic pain medications have increasingly been prescribed to treat chronic back pain.

See Narcotic Pain Medications

Prescription pain medication The powerful effects of narcotic pain medications call for special care.
Opioid Medication Potential Risks and Complications

In the past, usage of narcotics was limited to acute situations of severe pain, such as a traumatic injury or postoperative pain, because of the potential risk of addiction to if narcotic medications are used over a long period.

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

However, over the past 10 to 15 years, there has been an increased focus on the belief that the pain relief for patients suffering from chronic pain was more important than the potential risks.

Narcotic medications have, however, continued to be a double-edged sword, and although they work well as painkillers, they are reliably effective only when used for short durations of time (weeks).

See Opioid Medication Potential Risks and Complications

Rising Prescription Pain Medication Deaths

The consequence of this orientation to increasing prescriptions of opioids for treatment of chronic pain has had the unintended consequence of leading to a rapid increase death from opioid overdose (poisoning). Recent estimates are:

  • Since 1999, prescriptions for opioid pain medication have quadrupled. The increase in prescriptions correlates with the increase in deaths related to drug overdoses
  • More persons died from drug overdoses in the United States in 2014 than during any previous year on record.
  • In 2014, there were more drug overdose deaths in the United States than deaths from motor vehicle crashes.
  • In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths.
  • The problem is accelerating; between 2012 and 2014, the rate of drug overdose deaths involving synthetic opioids nearly doubled.

To further add perspective, more people are dying every year from prescription pain medications than from heroin and cocaine combined.1,2

See When Acute Pain Becomes Chronic Pain

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Painkiller tolerance and addiction

To be certain, not everyone who takes narcotic pain medications is an addict.

Most people who take narcotic pain killers will develop some tolerance to the medications if they use them for more than 2 to 4 weeks, and if taken on a daily basis for any longer than this time period, most people will also develop some habituation (urge to continue taking the medication on a daily basis).

See Pain Management for Chronic Back Pain

In patients who have developed a tolerance and habituation, they will have withdrawal symptoms when they discontinue taking the narcotics. This withdrawal process is a natural consequence of taking the medication and does not mean that the individual is addicted to narcotics.

Pain medication addiction is a more complicated process. It involves manipulative behavior to obtain narcotic medications and a refusal to discontinue a medication even though it is no longer being used for a medical purpose. Some, including those at significant risk of overdosing, will go to multiple doctors to get medications.1

See Pain Killer Addiction Treatment

Many addicted patients will go through a cycle of needing more and more medication in order to keeping getting the desired effects of the medication.

Abuse of narcotic medications defined as taking more than the prescribed amount and although all addicts are abusers, not all abuse is done by addicts (i.e. one time use of someone else's medication for recreational purposes).

See Pain Management for Chronic Back Pain

Many people assume that if a medication is prescribed by a physician it is safe to take. Physicians themselves often are responding to a request by a patient to get a prescription to relieve their symptoms. The process often starts off innocent enough, but then spirals into a downward cycle of overuse and dependence, with the potential to get worse.

See Chronic Pain As a Disease: Why Does It Still Hurt?

How opioid pain medications work

Narcotic medications work in a very similar manner to heroin, and even bind to the same receptor (the Mu receptor) in the brain. Our bodies make our own narcotic-like molecules (endogenous endorphins) that can bring about a feeling of well-being. An example of this is the "runners high" that people get after a hard workout.

Taking narcotic medications causes a "down regulation" of the Mu receptors, and with less receptors it takes more narcotic-like molecules, either endogenous or in pill form, for patients to get the same feeling.

See All About Neuropathy And Chronic Back Pain

Increased tolerance to narcotic medications

Taking narcotic medications may paradoxically cause patients to feel more pain as the loss of receptors does not allow the body to regulate the feeling of pain as well. This process is known as hyperalgesia.

It is this down regulation that leads to tolerance and a need for increased narcotics over time to get the same levels of pain relief.

See Chronic Pain Coping Techniques - Pain Management

Patients are advised to learn about narcotic medication risks

While prescription pain medication does play a key role in helping patients through periods of severe, acute pain, patients need to be aware of the risks or taking a narcotic medication for any amount of time.

Narcotics for short term pain carry little risk as they can be stopped before the patient becomes tolerant or habituated. However, if taken for long term chronic pain, tolerance and habituation can be expected, and taking the medications for a long period of time puts the individual at at significant risk for developing addiction and abuse.

Learn more:

Getting Adequate Pain Control After Back Surgery

11 Chronic Pain Control Techniques

Chronic Pain Coping Techniques - Pain Management


  1. "Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014," published Jan. 1, 2016, accessed June 3 2016.
  2. "CDC Grand Rounds: prescription Drug Overdoses – a U.S. Epidemic," Centers for Disease Control and Prevention, published Jan. 13, 2012, , accessed Nov. 5, 2012.
  3. Catan T, Barrett D, and Martin T, "Prescription for Addiction," Wall Street Journal Online, published Oct. 5, 2012, accessed Nov. 5, 2012.