Chronic back pain and the opioid crisis

Chronic back pain is a debilitating condition that affects hundreds of millions of people worldwide.

For decades, opioids were prescribed to manage the intense discomfort associated with back pain. However, the opioid crisis, driven by overprescription and misuse, has led to widespread addiction and devastating consequences.

At the same time, new clinical perspectives on back pain provide a revolutionary understanding that stress and psychological factors may be at the root of much of the pain - and that you can potentially become pain-free without resorting to drugs or surgery.

1. Prevalence of chronic back pain

Chronic back pain is one of the most common health complaints, affecting approximately 72 million adults in the United States alone.

While there are many potential causes of back pain - including herniated discs, degenerative disc disease, and spinal stenosis - many cases remain ambiguous and difficult to diagnose.

This uncertainty has led many healthcare providers to prescribe opioids as a catch-all solution, especially for patients whose pain seems resistant to other treatments.

2. Role of opioids in treating chronic back pain

Opioids, including drugs like oxycodone, hydrocodone, and morphine, have been widely used for the management of severe and chronic pain.

These drugs act on the brain to reduce the perception of pain, providing relief. However, their effectiveness comes at a significant cost. Opioids carry a high risk of dependency and addiction.

Long-term opioid use can lead to tolerance, meaning you may require higher doses over time to achieve the same level of relief, which further increases the risk of addiction and overdose.

A study in the Annals of Internal Medicine journal in 2015 examined the long-term effectiveness of opioid therapy. It found limited evidence that opioids provide long-term pain relief for chronic pain patients.

Instead, many patients developed opioid use disorder, highlighting the dangers of opioid reliance in treating chronic pain conditions like back pain.

3. Opioid crisis

The overprescription of opioids has led to an epidemic of addiction across the U.S., with more than 560,000 people dying from opioid-related overdoses since 2017, according to the Centers for Disease Control and Prevention (CDC).

Many of these people initially received opioids to manage chronic pain, such as back pain. Unfortunately, opioids’ addictive nature has caused many to become dependent on these medications, with some turning to illicit drugs like heroin when their prescriptions were no longer available.

A 2015 study in the journal Pain revealed that an alarming 21-29% of patients prescribed opioids for chronic pain - including back pain - misuse them, and between 8-12% develop an opioid use disorder.

This staggering statistic underscores the risks associated with opioid treatment for chronic back pain.

4. Problems with opioid treatment for back pain

While opioids have been commonly prescribed for managing chronic back pain, their use presents a range of serious issues, both for your health and well-being.

These problems stem from the nature of opioids themselves, their effect on your body, and the systemic risks associated with long-term use.

Although opioids can provide temporary relief, their downsides make them far from ideal as a sustainable solution for chronic back pain.

Addiction and dependency

One of the most significant risks of opioid use for back pain is the potential for addiction.

Opioids work by binding to receptors in the brain and spinal cord, altering the perception of pain and providing a sense of euphoria. While this might offer immediate relief, the brain quickly adapts to the presence of these drugs.

Over time, you will develop a tolerance, meaning you will need higher doses to achieve the same level of pain relief. This creates a dangerous cycle, increasing the risk of dependency and addiction.

Short-term pain relief can quickly and easily escalate into a long-term, life-altering addiction. What may begin as a necessary measure to manage pain can quickly spiral into a condition that is far more difficult to treat than the initial back pain itself.

Increased tolerance and diminished effectiveness

As your body builds tolerance to opioids, their effectiveness in managing pain decreases over time.

This diminished response means that, as you continue using opioids, they become less effective at controlling your pain. You may find yourself needing increasingly higher doses, which further raises the risk of addiction, overdose, and serious side effects.

Moreover, this tolerance does not just reduce the drug’s ability to alleviate back pain—it can also impair your body’s natural pain-regulating mechanisms.

Opioids can interfere with your brain’s ability to produce and regulate its own painkillers, like endorphins. As a result, when you stop taking opioids, your pain may feel even worse than it did before you began treatment.

This condition, known as hyperalgesia, leaves you more sensitive to pain and further dependent on medication.

Side effects and health risks

Even when used as prescribed, opioids come with a long list of potential side effects. These range from mild, such as constipation and nausea, to severe, including respiratory depression, overdose, and death. Some of the common side effects of long-term opioid use include:

• Sedation and cognitive impairment - Long-term opioid use can impair your ability to think clearly, affecting daily activities such as driving or working. This cognitive dulling can reduce your overall quality of life, leaving you less functional even if your pain is somewhat managed.
• Increased risk of depression and anxiety - Opioid use, particularly when it becomes chronic, has been linked to an increased risk of mental health disorders. Instead of alleviating your pain and suffering, opioids can exacerbate emotional issues, leading to a vicious cycle of increased pain sensitivity and worsening psychological health.
• Hormonal imbalances - Prolonged opioid use can disrupt your body’s endocrine system, leading to hormonal imbalances. This can affect your sex drive, cause fatigue, and even lead to issues like osteoporosis as your body loses its ability to regulate certain hormones effectively.
• Gastrointestinal problems - Opioids often cause constipation, but long-term use can lead to more severe gastrointestinal issues, such as bowel obstruction or opioid-induced bowel dysfunction. These conditions may require additional medications or treatments to manage.
• Respiratory depression - Opioids slow down your breathing, which can be fatal in the case of an overdose or if combined with other central nervous system depressants like alcohol or benzodiazepines.

5. Difficulty in weaning off opioids

For anyone who has relied on opioids for an extended period, weaning off these drugs can be a highly challenging process.

The withdrawal symptoms associated with opioids - such as nausea, muscle aches, insomnia, anxiety, and intense cravings - are often severe enough to discourage many people from quitting.

Even when you recognize the need to stop using opioids due to their harmful side effects or addiction risks, the physical and emotional toll of withdrawal can make it extremely difficult.

Many people relapse, returning to opioids even after they have started the process of weaning off, perpetuating a cycle of dependency.

6. Opioids don’t address the root cause of back pain

The major problem with opioids in treating back pain is that they mask the symptoms rather than address the root cause of the pain.

Chronic back pain is often a complex condition with multiple contributing factors, such as muscular imbalances, structural issues, or psychological stress. By focusing solely on alleviating pain, opioids can give you a false sense of progress, while the underlying issue remains unaddressed.

In many cases, back pain is not purely physical. Psychological factors, such as stress, anxiety, and emotional trauma, can play a major role in the experience of pain.

Opioids do nothing to address these underlying psychological drivers. Even if they temporarily relieve your pain, they don’t offer a long-term solution.

Instead of helping you understand and resolve the emotional or psychological factors contributing to your pain, opioids often keep you trapped in a cycle of reliance and frustration.

7. Stress and psychological factors

Dr. John Sarno, a renowned physician and professor of rehabilitation medicine, introduced the concept of Tension Myositis Syndrome (TMS) to explain how many forms of chronic pain, including back pain, are caused by repressed emotions, particularly stress and anxiety.

According to Dr. Sarno, your brain may use pain as a distraction from dealing with deeply rooted psychological stress or unresolved emotional issues.

Dr. Sarno explains that many cases of chronic back pain are not the result of physical abnormalities but rather emotional tension. Recognizing the psychological roots of your pain can help you become pain-free without the need for drugs, physical therapy, or surgery.

A 2023 study in the American Journal of Industrial Medicine found that individuals experiencing high levels of psychological stress were significantly more likely to report chronic back pain than those with lower stress levels.

This finding suggests that managing stress and emotional health can play a key role in alleviating back pain without reliance on medications like opioids.

8. Pain-free without drugs or surgery

Dr. Sarno’s approach to treating chronic back pain involves a combination of education, self-awareness, and a shift in mindset.

The key is to recognize that the pain is not solely a physical problem. By confronting your emotional issues - whether they are related to work stress, relationship difficulties, or unresolved past traumas - you can begin to break the cycle of pain.

Rather than relying on drugs, Dr. Sarno suggests that you focus on psychological healing. This might involve journaling, talking about your emotions, or simply acknowledging and accepting the sources of stress in your life.

Once you understand that your pain is a manifestation of emotional tension, it becomes easier to let go of the fear and anxiety surrounding the pain.

9. Future of back pain treatment

As the opioid crisis continues to claim lives, there is a growing recognition of the need for alternative treatments for chronic back pain.

Opioids may provide temporary relief, but their long-term consequences can be devastating.

In contrast, exploring the psychological aspects of pain, as proposed by Dr. Sarno, offers a drug-free, non-invasive alternative for many patients.

A balanced, more holistic approach to managing chronic back pain should consider not only the physical but also the emotional and psychological factors.

By addressing the root causes of pain—whether they are physical or mental—you can potentially achieve lasting relief without the dangerous side effects of opioids.

Conclusion

Chronic back pain is a multifaceted condition that requires a comprehensive, individualized treatment approach.

Opioids, while effective in the short term, are fraught with risks and do not address the emotional components of pain.

Dr. Sarno’s work has paved the way for a deeper understanding of how stress and psychological factors play a significant role in chronic pain - and how you can find relief without drugs, surgery, or exercise.

Always consider consulting health professionals, such as physicians, psychologists, or pain specialists, to design a treatment plan tailored to your specific needs and conditions.

References

Chou, R., Turner, J. A., Devine, E. B., Hansen, R. N., Sullivan, S. D., Blazina, I., Dana, T., Bougatsos, C., & Deyo, R. A. (2015). The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a national institutes of health pathways to prevention workshop. Annals of Internal Medicine

Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., Ney, J. P., van der Goes, D. N. (2015) Prescription opioid misuse and risk factors for opioid addiction in chronic pain patients: a comprehensive review. Pain

Yang H., Lu M.L., Haldeman S., Swanson N. (2023) Psychosocial risk factors for low back pain in US workers: Data from the 2002-2018 quality of work life survey. American Journal of Industrial Medicine