Opioids for Severe Back Pain and Neck Pain

Appropriate opioid use, special considerations, potential side effects, and working with your prescriber to maximize control of your back/neck pain.

Opioids are a misunderstood class of prescription pain medications. Because of certain controversies surrounding opioids, some doctors may shy away from prescribing them. Similarly, some patients may feel uncomfortable taking an opioid to reduce and manage back or neck pain because they're afraid of becoming addicted.

Your doctor may prescribe an opioid to help reduce and manage your moderate to severe pain that may be acute, chronic or episodic. Many causes of spine-related pain may fit into one of those descriptions, such as cancer and post-operative pain.
Doctor wearing white work coat with a stethoscope around his neckWhat are opioids and how do they work to reduce pain?
Opioids belong to a class of drugs and medications known as analgesics. The medications in this class vary widely, but the one similarity all analgesics share is that they are pain relievers. Opioids are powerful prescription-only analgesics.

Opioids work by essentially decreasing your perception of, and therefore your reaction to, pain. They do this by interacting with specific proteins called opioid receptors. Opioid receptors are located throughout your body, but when opioid medications attach to receptors in your brain and spinal cord, they alter your perception of pain.

Listed below are types of opioids that may be prescribed for back and/or neck pain. The brand name( (in parentheses) are not inclusive.

  • Codeine (generic)
  • Fentanyl (Actiq, Duragesic, Fentora)
  • Hydrocodone (Hysingla ER, Zohydro ER)
  • Hydromorphone (Dilaudid, Exalgo)
  • Meperidine (Demerol)
  • Methadone (Dolophine, Methadose)
  • Morphine (Avinza, Kadian, MS Contin, others )
  • Oxycodone (OxyContin, Roxicodone)
  • Tramadol (Ultram)
  • Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)
  • Oxycodone/acetaminophen (Percocet, Endocet, Roxicet)
  • Oxycodone/naloxone (Targiniq ER)

When Opioids Are Appropriate
If you have moderate to severe back pain or neck pain, have exhausted all other viable medication options, an opioid may be an effective treatment for you. Before your doctor prescribes an opioid pain reliever, he/she will likely evaluate your current medical condition by performing a physical and neurological examination. The assessment focuses on your pain—including the location, intensity, frequency, and treatments you’ve tried.

Risk Assessment and Treatment Agreement
Your doctor will ask if you (or a close family member) have a history of substance abuse (eg, alcohol, drugs), because opioids have the potential of addiction and abuse. If you have struggled with substance abuse, you are at a greater risk of becoming addicted to opioids. Some doctors have additional screening protocols for these risks, such as questionnaires and urine tests.

Before opioid therapy begins, your doctor (eg, pain medicine specialist) explains his/her opioid policy with you. The policy may include instructions—do not obtain analgesics from another prescriber, how refills are handled, keeping your drugs safe from others, use of a single pharmacy, and scheduled appointments. Signing a treatment contract confirms your opioid treatment agreement with the doctor—this is a standard practice, so don’t feel embarrassed or offended. During opioid therapy your doctor monitors you to ensure the medication is safely helping you manage your pain. Monitoring usually includes random urine drug screens.

Potential Side Effects of Opioids
Your prescribing doctor and pharmacist are good resources to learn about potential side effects caused by an opioid, or any other medication. Always keep your doctor informed about any side effect you develop. Some common side effects from opioid use may include the following:

Special Considerations When Taking Opioids
Reports of opioid addiction and resulting deaths have made some doctors hesitant to prescribe the medications to their patients. Similarly, some doctors prescribe doses that are too low to adequately manage severe chronic pain. They might do this out of fear that their patients may experience adverse side effects.

Exacerbating the problem is the fact that it's quite common for people to develop a tolerance to opioids, which requires increasing the dose to help deliver better pain relief. This makes determining the right dose a somewhat tricky process. All people develop some level of tolerance, and it can become a difficult cycle.

Another problem is that people may resist taking an opioid—or take it less often than directed—out of fear of becoming addicted to it. This results in less or loss of pain control, which is the purpose for taking the opioid in the first plan. If pain medication is taken as prescribed, it can help you stay ahead of the pain.

The seriousness of opioids' addictive potential should not be overlooked or taken lightly. However, opioids are effective medications against pain when they are used exactly as your doctor directs.

If your doctor prescribes an opioid to help you better manage your pain, listen to him/her carefully about how it should be used. Ask your doctor or pharmacist questions about the safe use of opioids. If you use the medication as directed, not only is your risk of addiction less, but the odds of enjoying a better quality of life will be in your favor.

Updated on: 07/25/17
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How Do Topical Drugs Reduce Back and Neck Pain?

Many different types of medication with different methods of delivery are available to treat patients with back and neck pain.
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