Got back pain or a migraine? Read this before you pop a painkiller.


When it comes to narcotic painkillers, close to 50 percent of abusers are women-which suggests there's something about these drugs that draws them in. One explanation, Traci C. Green, PhD., a drug abuse epidemiologist at Brown University School of Medicine explains, is that women are more likely than men to seek help for their pain-and to leave the doctor's office with a prescription. Also, conditions associated with chronic pain affect women in greater numbers. Hormones may play a role as well: Higher levels of estrogen make women more susceptible to feeling a high from opioids, so the temptation to use them may be stronger.

No one intends to end up an addict-and most of us won't. Any expert will tell you that the vast majority of people who take Rx painkillers don't abuse them. Still, to avoid becoming a statistic, it pays to learn the facts about these powerful drugs. Here's what you need to know before asking for-or filling-a prescription.

Consider OTCs

Just because your doctor is willing to give you painkillers doesn't mean you have to take them. Keep in mind that, as the FDA noted when it recently announced a new plan to fight the epidemic of prescription drug abuse, some types of pain medicine are "extensively misprescribed."

Narcotics are recommended for moderate to severe pain; if your pain is mild to moderate, you can probably manage it with nonnarcotic over-the-counter (OTC) choices like ibuprofen, a topical analgesic cream (such as Aspercreme), or a lidocaine patch that's applied at the site of your pain, says Jerry Lerner, M.D., chief of pain medicine at Sierra Tucson, a treatment center in Tucson, AZ. "If you need something stronger, you can always switch to prescription meds," he adds, "and then go back to the OTCs once your pain lessens."Know your risk factors"About 10 percent of the population has a genetic predisposition to addiction, whether it's to painkillers, alcohol, or substances like nicotine," says Russell Portenoy, M.D., chairman of the department of pain medicine and palliative care at Beth Israel Medical Center in New York City. "A personal or family history of alcohol or substance abuse suggests that you may be one of these people." Other risk factors include suffering from a psychiatric condition like depression, anxiety, or bipolar disorder, or having experienced past trauma, such as sexual or emotional abuse.

"If, after discussing your medical history, your doctor feels your risk is elevated," says Portenoy, "expect that she will prescribe only a few pills at a time, will require frequent office visits, and may want to work in consultation with a pain specialist or addiction counselor."

Tune in to your body

For the average person, a painkiller relieves suffering and may cause some side effects, such as drowsiness, constipation, and fuzzy thinking. If it gives you a lift or a sense of control, tell your doctor. Feeling a buzz or a hit of euphoria doesn't mean you're definitely on the path to addiction, but it's a red flag.

Be watchful, too, if you're under a lot of stress. "Narcotics should only be used to ease physical symptoms," says Lerner. If you find you're using a drug to numb negative emotions or "make it all go away," your treatment may need to be changed.Don't rely only on drugs

No matter what the reason for your discomfort-migraines, an injury that's not getting better, or a chronic condition like cancer- pills shouldn't be your only source of relief after a week or two, says Scott Fishman, M.D., professor of anesthesiology and chief of the division of pain medicine at the University of California, Davis. "Physical therapy, counseling, alternative medicine like acupuncture, or surgery can help you resume your normal life."

Get off the meds safely

The longer you're on painkillers, the more likely it is that your body will develop a tolerance for them. "People may end up addicts because they need increasing amounts to get the same effect," says Coleman. It's impossible to estimate how quickly you could become physically dependent, because everyone is different, but if you take painkillers for much longer than a week, you may experience withdrawal when you stop. "To prevent this scenario, your doctor should wean you off of them gradually by tapering your dose," advises Coleman.

Reach out for help

Unfortunately, most people who become addicted to narcotics can't stop on their own. A three- to 30-day detox in a medical setting may be required. "But detox is just the tip of the iceberg," says Neil Capretto, medical director of Gateway Rehabilitation Center in Pittsburgh. "We need to teach people coping tools so they can live without the drug, or the problem will come back."