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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.

Chronic Back Pain Exercises

Exercises you should and shouldn't do when you have back pain.
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