A patient I saw recently had a bad experience in her doctor’s office related to narcotics. A new doctor decided to quickly get her off narcotics - and the patient experienced needless physical and emotion suffering.

Unfortunately, problems related to narcotics are common. The issues surrounding narcotics are very complicated, and include…

• medical (what types of pain do they work in; what serious side effects they can cause)
• psychological (do they cause apathy - making people not care enough about getting better to work at it)
• addiction
• legal (many laws about their prescription)
• religious (our society’s Puritan background causes doctors to underprescribe narcotics, even when they’d be very helpful; patients too can be very  hesitant to use these medications)

There is good evidence that narcotics, or “opiates,” work for pain and in pain disorders. Medical evidence shows narcotic treatment works for chronic pain, including neuropathic pain. Previously, some physicians believed that neuropathic pain, which is pain from nerve injuries, didn’t respond to narcotics. We now know that some patients do respond, somewhat, to narcotic treatment for nerve pain.

The problems associated with narcotics are, unfortunately, many. They include:

1. Losing their affect
Over time, narcotics often becomes less effective. Reasons for this include your body adjusting to one dose, so they work less well. There is also some evidence that narcotics, at least in some people, cause changes that make you more sensitive to pain over time.

2. Significant side effects
These include sedation, slower thinking, nausea, bowel problems, and more.

3. Hormonal and immune changes
When narcotics are used in high doses for long periods, there can be problems with your body’s hormonal and immune (illness-fighting) systems.

4. Addiction
Addiction is using narcotics to the point of more and more life problems related to the drugs, but your not caring about these negative consequences. This can include buying or selling narcotics. However, addiction is actually rare. Just because your body is used to a certain dose, and you’d have withdrawl symptoms if you stopped, doesn’t mean you’re addicted.

What is more common is inappropriate use, e.g. using not the medication for pain, but when you’re stressed, or to get a “buzz.”

5. Better function
The question is still out if narcotics allow you to function better, for example, go back to work or care for your family.

This is, of course, not a full discussion of all the issues related to opiates. Your doctor can answer your questions about your particular condition. Some doctors rarely use narcotics for chronic pain conditions. Some use narcotics in nearly every patient.

What’s most important if you’re using narcotics? Are the benefits greater than the problems these medications might cause for you? And, are you functioning noticeably better?

For more information, see “Opioids for Chronic Non-terminal Pain,” by Jane C. Ballantyne, MD, FRCA, in the Southern Medical Journal, November 2006, pages 1245-1255.