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Back Pain: Medication and Addiction

There are risks involved with prescription drug addiction, specifically narcotic painkillers. In most cases, the benefits of these medications outweigh the risks.

Who Is at Risk?

Most people who have back pain are not at risk of prescription drug addiction for a number of reasons. First off, the majority of people with back pain never get prescribed potentially addictive painkillers in the first place.

"Most of the people with back pain will take drugs that don't pose a risk of addiction," says Larry Khoo, MD, co-director of the UCLA Comprehensive Spine Center. People with back pain often use non-addictive medications like Tylenol or nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs are over-the-counter, like Motrin or Advil, and others are by prescription. In April 2004 the FDA asked that over-the-counter NSAIDs revise their labels to include information about potential heart and stomach ulcer bleeding risks.

Steroids can also be prescribed for pain due to swelling and inflammation. Steroids are not narcotics either, but these powerful drugs must be used carefully.

While opioid narcotics like OxyContin, Percocet, and Vicodin are options for patients with acute pain that's more severe, the risks of developing prescription drug addiction still aren't very high.

"Most of the people who need opioid drugs will only use them for a very short time, often a few weeks or a month," says Khoo. "Even the most powerful drugs are not very addictive when they're used that way."

Khoo says these drugs relieve pain immediately and allow people to get out of bed, start physical therapy, and change some of the behaviors that caused their back problem in the first place. "But it all hinges on being able to get out of bed," says Khoo, and without these drugs, that first step is sometimes just too painful.

While some treatments and physical therapy work for most people, Khoo says there are some problems that don't respond to this approach. Despite a good treatment plan, the pain remains. Khoo says patients who develop chronic back pain often have multiple problems with the spine, due perhaps to arthritis or a history of heavy labor, that can't be corrected surgically. He also says people who don't respond to one or two surgeries are more likely to develop difficult-to-treat chronic pain.

It's this small population of people who have chronic pain and hard-to-treat problems that usually need long-term medication, Khoo says.

What Increases the Risk of Abuse?

According to rough estimates, between 3%-16% of people who suffer from chronic pain and are treated with long-term opioid narcotics have a prescription drug addiction, says Miotto. But what increases the risk?

According to Zacny, we still don't have a perfect way of knowing. "The studies just haven't been done," he says. However, most people agree that a recent history of any substance abuse may increase the danger.

Other possible risk factors for prescription drug addiction include any personal or family history of substance abuse, as well as recent emotional or psychiatric problems. "If you're in a high-risk group, if you or a family member has had a past history of addiction, or you're coping with a great deal of stress, you and your doctor may need to be especially vigilant," says Miotto.

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