These popular drugs can muddle your thinking and make your pain worse.

If you have ever suffered from severe pain, you probably know that a strong pain pill can seem like the holy grail. In fact, with chronic pain affecting about one-third of Americans—or roughly 100 million people—it’s perhaps no surprise that the most commonly prescribed medication in the US is a painkiller, hydrocodone (Vicodin).

Frightening trend: Hydrocodone and the other prescription opioid painkillers (also known as narcotics) have now overtaken heroin and cocaine as the leading cause of fatal overdoses, according to the Centers for Disease Control and Prevention.

Why the shift?

Until recently, prescription opioids were used to treat only acute (severe, short-lived) pain, such as pain after surgery or an injury or pain related to cancer.

Now: As doctors have stepped up their efforts to better control pain in all patients, opioids are much more widely prescribed. These powerful medications are now being used to treat chronic painful conditions such as low-back pain, chronic headaches and fibromyalgia.

What pain sufferers need to know…


Each day, an estimated 4.3 million Americans take hydrocodone or other widely used opioids, such as oxycodone (Oxycontin), hydromorphone (Dilaudid), codeine and morphine. For some patients, opioids are prescribed as an alternative to nonsteroidal anti-inflammatory drugs (NSAIDs), which are notorious for causing gastrointestinal bleeding and other side effects, including increased risk for heart attack and kidney disease.

Opioids work by mimicking natural pain-relieving chemicals in the body and attaching to receptors that block the transmission of pain messages to and within the brain. These drugs can be highly effective pain relievers, especially for arthritis patients who can’t tolerate NSAIDs.

But opioids also have potentially serious side effects, especially when they’re used long term (usually defined as more than 90 days). While the effectiveness of the medications often decreases over time (because the patient builds up a tolerance to the drug), the risk for side effects—including constipation, drowsiness or even addiction—increases due to the higher and more toxic doses used to overcome tolerance.

Continuous use of these pain medications also can have far-reaching health effects that can include a heightened risk for falls and fractures…slowed breathing…concentration problems…and vision impairment. And these drugs can compromise the immune system, resulting in susceptibility to infection.

Men who take opioids long term are five times more likely to have low testosterone levels, which can curb libido and result in erectile dysfunction. Even at low doses, such as 20 mg of morphine, opioids can diminish alertness and have been shown to increase risk for car accidents by 21%.


If your doctor suggests taking an opioid for back pain, chronic headaches or migraines, or fibromyalgia, ask him/her about trying the following nondrug treatments first. Opioids should be considered only as a last resort.

  • Back pain. For long-term low-back pain, exercises that strengthen the abdomen and back (or “core”) muscles are the most effective treatment. If the pain is so severe that you can’t exercise, over-the-counter painkillers sometimes can alleviate the pain enough to start an effective exercise regimen.Bonus: Exercise can ease depression, which is common in back pain sufferers. Yoga may also be effective because it stretches the muscles and ligaments in addition to reducing mental stress.Other possible options: If the approaches described above don’t provide adequate relief, you may be a candidate for steroid injections into the spine or joints…a spinal fusion…or disk-replacement surgery. In general, these treatments have less risk for adverse effects than long-term use of opioids.
  • Chronic headaches or migraines. With chronic headaches or migraines, opioids can worsen pain by causing “rebound” headaches that occur when the drug is overused. Try lifestyle changes, such as daily meditation, and the sparing use of mild painkillers, such as NSAIDs. Supplements, including magnesium and feverfew, also have been shown to relieve headache pain.
  • Fibromyalgia. With this condition, which has no known cure, opioids have been found to intensify existing pain. Much better: A review of 46 studies has found aerobic exercise, such as brisk walking or pool aerobics (done two to three times a week for an hour), may reduce system-wide inflammation, making it an effective treatment for fibromyalgia.If you’re in too much pain to do aerobic exercise, a mild painkiller or a nondrug approach, such as massage, may allow you to start.Cognitive behavioral therapy is another good choice. With this treatment, a therapist can help you reframe negative thoughts that may be fueling fibromyalgia pain.

Additional nondrug approaches that may help all of these conditions: Acupuncture, relaxation exercises and heating pads.


Some people who take opioids are more likely to become addicted than others. Risk factors include…

  • Depression, anxiety or some other psychiatric condition (current or in the past).
  • Substance abuse. This includes alcohol or other drugs (current or in the past).
  • Poor coping skills. Those with “catastrophizing” personalities—they tend to imagine the worst possible outcomes in trying situations—are more likely to develop chronic pain and drug dependence.

Before using an opioid, discuss your potential for addiction with your physician. You want a doctor who understands the risks and benefits of the drug…who is aware of your potential for dependence and addiction…and who will take you off the drug if he/she notices problematic behavior. See your doctor often—at least monthly when you first start taking the drug.