Who Needs Opioid Painkillers? continued...
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.
How Big Is the Opioid Abuse Problem?
Prescription narcotic abuse is a serious issue, says Jim Zacny, PhD, a professor in the department of anesthesia and critical care at the University of Chicago. He points to the 2007 National Survey on Drug Use and Health. It found that as many as 5.2 million people reported using prescription opioids in the last month for non-medical reasons. That's more than double the number of people who used cocaine.
But many of the people illicitly using these drugs are not in pain. So the important question is this: how high is the risk of abuse for someone living with serious back pain?
There's some good news: the risks of actual addiction may be lower than assumed. "Among people with legitimate pain issues, it's a very small group who actually develop the disease of addiction," says Webster.
Zacny agrees. "There's this myth out there that if you take an opiate, you automatically become enslaved to it," he says. "That's not the truth at all."
However, addiction isn't the only issue. Webster observes that a much larger number of these people -- perhaps 20%-30% -- do wind up misusing or abusing the drug.
Opioid Addiction vs. Abuse
What's the distinction between drug addiction and drug abuse? Many people with real back pain aren't addicted, but they may begin to use their medication incorrectly. They might take too much, simply because the prescribed dose doesn't seem to be helping enough. Or they might use their medication to cope in other ways.