Prescription opioid medications can help manage back and neck pain, but these drugs pose significant risks for abuse, addiction, and other negative side effects. These and other concerns have led to a reduction in prescriptions and stricter guidelines for use. But occasionally doctors still prescribe opioids to patients who need them. Here’s what you should know about this complicated situation.

Opioids may be an option for treating different kinds of back pain but they carry the risk of misuse, abuse, and addiction. See Opioids for Back Pain: Potential for Abuse, Assessment Tools, and Addiction Treatment

Opioids are typically prescribed for acute pain, not chronic pain

Opioids can be helpful for treating severe, acute pain, such as a traumatic injury or pain after back surgery. Less common today is a doctor prescribing opioids to treat a long-term, chronic back pain condition. The reason for this protocol is that the longer a person takes opioids, the higher their risk of becoming dependent or addicted.

See Opioid Medication Potential Risks and Complications

Doctors want to help patients manage their back pain, but they also want to help patients avoid the risks that come with long-term opioid use. To avoid these risks, many doctors opt for non-opioid therapy to treat patients with chronic pain. Doctors will prescribe opioids for back pain if they believe the expected benefits outweigh the risks.

See Chronic Pain Coping Techniques - Pain Management

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Physical dependence and addiction are different

When discussing opioid risks, it is easy to confuse dependence with addiction. Here’s how doctors distinguish these two conditions:

  • Dependence. Most people who take opioids for longer than 2 to 4 weeks develop a physical dependence, or tolerance, to the medications. When a person with a physical dependence stops taking opioids, their body typically responds with withdrawal symptoms, which may include diarrhea, increased pulse, sweating, muscle aches, increased pain, restlessness, and anxiety. Withdrawal symptoms are a natural consequence of taking opioids, and signs of dependence do not necessarily mean a person is also addicted.
  • See Opioid Detoxification and Withdrawal

  • Addiction. Opioid addiction involves many factors and results in compulsive, unrestrained opioid use, gradually requiring higher amounts to reach the desired effect. People who are addicted to opioids often use manipulative behavior to obtain opioids and/or refuse to discontinue their medication even though it’s not being used for medical reasons, and some will go to multiple doctors to get medications. Almost all people who are addicted to opioids are also dependent on them.

See The Difference Between Opioid Addiction and Physical Dependence

Many people assume that if a medication is prescribed by a physician, it will not cause harm. Although the process can begin innocently enough, there is serious potential for a cycle of overuse, dependence, and addiction.

If addiction occurs, seek treatment

Some people who use opioids for back pain will become addicted. If opioid addiction does occur, rehabilitation programs are available. These programs may be inpatient or outpatient, and they are designed to facilitate recovery and treat the whole person.

See Opioid Addiction: Medication Assisted Treatment (MAT)

Some rehabilitation facilities incorporate pain management, teaching people how to manage chronic back and neck pain without relying on medication. But not all facilities integrate pain management, so a person in recovery may need to seek separate pain management treatment with a health care provider.

See Opioid and Substance Use Disorder Rehabilitation and Maintenance

Learn more:

Assessment Tools for Opioid Misuse, Abuse, and Addiction

Opioid Pain Medications