Should You Worry About Your Back Pain Meds?

Medically Reviewed by Smitha Bhandari, MD on December 08, 2021

If you're one of some 26 million Americans who live with frequent back pain, relief is likely at the top of your wish list. Constant pain can disrupt your daily routine and bring down your quality of life.

Most people with a mild, general backache (meaning isn’t related to another condition like cancer) will treat it with over-the-counter pain relievers or home remedies like heat and ice. If you have more severe pain, your doctor might prescribe an opioid pain reliever like hydrocodone (Hysingla ER; Zohydro ER) or oxycodone (OxyContin, Percocet). Or they might pair the hydrocodone with acetaminophen (Lorcet, Norco, Vicodin) or oxycodone with acetaminophen (Endocet, Percocet). About 1 in 5 people who see a doctor for chronic pain get an opioid prescription.

These drugs do relieve back pain for short periods, but they're strong -- and they come with some serious risks. Taking opioids long-term can lead to unpleasant side effects. You’re also more likely to have these problems:

  • Tolerance is when your body gets so used to the drug that you need to take more and more of it to get the same effect.
  • Acetaminophen overdose: Too much of an opioid with acetaminophen can damage your liver and lead to organ failure.
  • Physical dependence is a constant need by your body for the drug, even when you aren’t in pain. Stopping the drug leads to withdrawal symptoms like chills, trouble sleeping, nausea, vomiting, and diarrhea.
  • Addiction means you crave the drug, think about it obsessively, and can't stop yourself from taking it. Some people become so hooked on opioids that they'll do just about anything -- including seeing multiple doctors and lying about their pain -- to get them.

Taking too much of these drugs could be deadly. Every day, 90 Americans die from an opioid overdose. 

These risks can leave you with a challenging decision: Should your pain treatment plan include opioids given the side effects and risk of addiction?

The Problem With Painkillers

Doctors recommend a few different medicines to treat back pain. Some of them -- like NSAIDs and topical pain relievers that you rub on your skin -- aren't addictive. Others, especially opioids, can become habit forming.

Opioid addiction has been a growing problem since the 1990s, when drug companies assured doctors these pain relievers weren't addictive. As a result, doctors began to prescribe opioids for their patients with chronic pain more and more.

Today, opioid addiction is such a serious problem that health officials call it an epidemic.  Find out what happens when prescription drug addiction goes untreated.

Still, doctors continue to prescribe these drugs. Nearly 2 million Americans, aged 12 or older, either abused or were dependent on prescription opioids in 2014.

Addiction isn't the only risk tied to opioid use. People who regularly take these drugs are also more likely to develop these health problems:

  • Heart attack
  • Depression
  • Erectile dysfunction (in men)
  • Injury from a motor vehicle accident
  • Sleep apnea
  • Lung damage
  • Accidental overdose

In the short term, opioid drugs can make you:

  • Drowsy
  • Constipated
  • Nauseated
  • More likely to fall and break a bone

Who Gets Addicted?

It doesn’t happen to everyone. Most people won't ever have a problem. Between 15% and 26% of people who get an opioid prescription for chronic pain misuse or abuse them. Just under 8% of those who take opioids will become addicted.

There’s no way to know whether you'll become addicted to your pain medicine. But a few things make it more likely:

  • Your family history. Genes are strongly linked to your odds of addiction. A close relative -- like a parent or sister -- with an opioid addiction makes it more likely to happen to you.
  • Your age. Younger people are more likely to become addicted than older adults.
  • Your history of substance abuse. A past problem with drug or alcohol addiction can raise your chances.
  • Your mental health. People with major depression are more likely to abuse these drugs.
  • Your use of antidepressants and antipsychotic drugs. People who take these medicines are more likely to become addicted to opioids.

None of this means you have to avoid prescription pain relievers. You and your doctor may just need to be extra watchful for signs of addiction.

How to Avoid Addiction

The best way is not to take these drugs in the first place. Try non-medication pain relief methods -- like physical therapy, heat, or ice -- and non-opioid painkillers such as NSAIDs (Motrin, Advil).

If you're still in pain, it's fine to consider adding opioids to your other pain treatments, but only if you and your doctor agree that the relief you'll gain from them outweighs the risks. You might go to a doctor who specializes in pain management. They can help you get the best relief and avoid complications.

You’ll take the lowest possible dose to ease your pain for a short period. Before you start, your doctor will work with you to set treatment goals. You’ll see them every few months for follow-up visits to check your progress.

Your doctor can slowly increase the dose if you need more relief. And if your pain doesn't improve within 1 to 4 weeks, make a plan to get off these drugs and try something else.

Show Sources


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Mayo Clinic: "Back pain: Diagnosis & treatment."

Johns Hopkins Medicine: "7 Ways to Treat Chronic Back Pain Without Surgery."

Choosing Wisely: "Medicines to Relieve Chronic Pain."

BMJ: "Opioids for low back pain."

The New England Journal of Medicine: "Opioid abuse in chronic pain--misconceptions and mitigation strategies."

National Institute on Drug Abuse: "Opioid Overdose Crisis."

U.S. Department of Health & Human Services: "About the Epidemic."

Truven Health Analytics: "Health Poll: Back Pain."

Pharmacoepidemiology and Drug Safety: "Coronary heart disease outcomes among chronic opioid and cyclooxegenase-2 users compared with a general population cohort."

Spine: "Prescription opioids for back pain and use of medications for erectile dysfunction."

JAMA Internal Medicine: "Opioid dose and risk of road trauma in Canada: a population-based study."

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Medscape: “Acetaminophen Toxicity.”

CDC: “CDC Guideline for Prescribing Opioids for Chronic Pain.”

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