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People living with serious back pain have to sort through a lot of mixed messages about opioid -- or narcotic -- painkillers.

On the one hand, you've heard stories about the seeming epidemic of addiction to these drugs, like OxyContin, Percocet, and Vicodin. All those celebrities checking into rehab for painkiller addiction may give you the impression that the lure of these drugs is irresistible, that we're all just a few pills away from addiction.

But on the other hand, you might have heard that pain is chronically undertreated and many people are suffering needlessly. Which is true?

"They're both true," says Lynn Webster MD, medical director at the Lifetree Clinical Research and Pain Clinic in Salt Lake City. "In this country, we undertreat pain and we underutilize opioid painkillers. But we've also had a serious increase in the misuse and abuse of these drugs."

This leaves many people with chronic back pain -- and often their doctors -- stuck in the middle. On the one hand, people are afraid of the risks of drug abuse and addiction that come with powerful painkillers. On the other, they're suffering from severe and debilitating pain and need some kind of help.

Opioid medicines can save lives. But they can destroy them too. What's an average person with severe back pain supposed to do?

Who Needs Opioid Painkillers?

Here's one piece of good news: most people with back pain don't need these powerful painkillers to begin with.

Many with back pain often just use non-addictive medications like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs are sold over the counter, like ibuprofen or naproxen, and others are sold by prescription. Steroids can also be prescribed for back pain due to swelling and inflammation. These drugs do have some risks of their own, but the potential for addiction is not among them.

Even when powerful opioids like Percocet and Vicodin are necessary, many people only need them in the short term. After an acute back injury or surgery, many just use these drugs to ease the pain enough that they can start moving around and begin physical therapy.

But sometimes, the back pain lingers. Chronic back pain can sometimes develop as a result of arthritis or injuries that can't be corrected surgically. In the small percentage of people with chronic and hard-to-treat back pain, a doctor may recommend long-term opioid therapy. Others may get opioid therapy if the side effects of other painkillers -- like NSAIDs -- are too risky.

While some patients and doctors swear by opioids as a treatment for severe chronic back pain, the evidence is not all that strong. One 2007 review in the Annals of Internal Medicine found that while opioids do help with short-term back pain, it's not clear that they help with chronic back pain. A 2007 Cochrane Review found that opioids may not work any better than an NSAID for chronic lower back pain.

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