Choosing Wisely

Medicines to Relieve Chronic Pain

When you need opioids (narcotics)—and when you don’t

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Opioids (narcotics) are common pain medicines. They can help if you have bad short-term pain —like pain after surgery for a broken bone. They can also help you manage pain if you have an illness like cancer.

But opioids are strong drugs. And usually they are not the best way to treat long-term pain, such as arthritis, low back pain, or frequent headaches. This kind of pain is called “chronic” pain. Before getting opioids for these problems, you should discuss other choices with your doctor. Here’s why:

Opioids are prescribed too often.

Chronic pain is one of the most common reasons people see the doctor. One in five of these patients gets a prescription for opioids.

Common opioids include:

  • Hydrocodone (Vicodin and generic).
  • Oxycodone (OxyContin, Percocet, and generic).

Short-term use of these medicines may help. But there is no proof that they work well over time.

Opioids have serious side effects and risks.

Over time, the body gets used to opioids and they stop working as well. To get the same relief, you need to take more and more. Higher doses can cause serious side effects:

  • Nausea
  • Vomiting
  • Itching
  • Constipation
  • Not being able to urinate enough
  • Breathing problems, which can be deadly
  • Confusion and mental disturbance

Opioids can be very addictive. Up to one in four people who take opioids long-term become addicted. Worst of all, every day, 46 Americans die from an overdose of opioid painkillers. And hundreds more go to the emergency room.

Opioids can be expensive.

Some opioids, such as oxycodone, can cost over $1,000 each month. A good insurance plan may cover the drugs. But if you have bad side effects, you might still spend a lot.

Other pain treatments may work better and have fewer risks.

Pain medicine specialists say that usually you should try other treatments first:

  • Over-the-counter medicines (see Advice column)
  • Non-drug treatments:
    • Exercise
    • Physical therapy
    • Spinal manipulation
    • Massage therapy
    • Acupuncture
  • Injections, such as steroids
  • Other prescription drugs (ask about risks and side effects):
    • Non-steroidal anti-inflammatory drugs (NSAIDs)
    • Anti-seizure drugs

When should you consider taking opioids?

You have cancer with severe pain: Opioids may be the right choice if pain is a bigger concern than the possibility of addiction and the need to keep increasing the dose.

You have chronic pain that is not caused by cancer: Only use opioids when the pain is strongest. Your doctor should check you often.

If you need around-the-clock pain relief and other treatments are not helping enough: In this case, your doctor may consider an extended-release opioid like oxycodone, morphine, and the new drug Zohydro ER (a long-acting version of hydrocodone). Don’t use long-acting drugs simply because it’s easier to take fewer pills.

What should you do if your doctor prescribes opioids?

Talk to your doctor about the possible side effects and risks. Watch for side effects and signs of addiction. These include unusual moodiness or bursts of temper, cravings, and risk-taking.



Advice from Consumer Reports

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2014 Consumer Reports. Developed in cooperation with the American Society of Anesthesiologists. To learn more about the sources used in this report and terms & conditions of use, visit