For severe episodes of low back pain, narcotic pain medications may be prescribed. Clearly, narcotic agents are strong and potentially addictive forms of medication and should only be administered by a physician.
All narcotic agents have a dissociative effect that helps patients manage pain. It does not actually deaden the pain, but works to dissociate patients from the pain. Commonly used narcotics, listed in ascending order of potency (strength) include:
codeine (e.g. Tylenol #3)
propoxyphene (e.g. Darvocet)
hydrocodone (e.g. Vicodin)
oxycodone (e.g. Percocet, Oxycontin)
In general, narcotic medications can be highly effective in treating back pain for short periods of time (less than two weeks). After the initial two weeks, the body rapidly builds a natural tolerance to narcotic medications and they lose their effectiveness. While some physicians believe that narcotics can be used long-term at low doses to treat chronic pain, narcotics are most commonly used to treat severe acute (short-term) low back pain or post-operative pain.
Narcotic agents have several major side effects and potential risks, such as:
Impairment of mental function and drowsiness. Patients taking a narcotic should avoid driving or operating heavy machinery.
Significant constipation. Patients taking narcotics should take care to include extra fiber in their diet, and possibly use laxatives, to avoid constipation.
Addiction. Addiction to narcotics is a possible, but unlikely, event.
Drug interaction with acetaminophen. Most narcotic agents have acetaminophen in them and should not be taken with additional acetaminophen. Patients should not take more than the recommended dosage (usually two every four hours as needed for pain) since this can lead to dangerous levels of acetaminophen.
In addition to pills, narcotic agents may be taken in slow release form through a patch (e.g. Duragesic). Duragesic releases the medication fenatnyl through a transdermal patch over a 72-hour period. Because it is slow release it has lower abuse potential and outright addiction is rare, however it still has the potential for physical dependence and tolerance. It has all the potential side effects of any Schedule 2 narcotic (like morpine), such as altered cognigition and respiratory depression. Care should be taken not to take too many other narcotic agents (e.g. short acting pills such as Vicodin) because of the potential of narcotics overdose. Duragesic is indicated for use of the treatment of severe pain, especially in patients with malignant cancer.
By: Peter F. Ullrich, Jr., MD
Updated January 10, 2007
