Narcotics (also called opioids) are powerful medications to control pain. However, they have several drawbacks and are best reserved for when all other methods have failed.  Even then, I suggest adding them to the existing pain-control regimen so as to use as little narcotic as possible. 

Most of the cautions when using narcotics have to do with tolerance, dependency, and addiction. Tolerance is when the body "gets used to" a certain dose of a medication (or drug) such that a higher dose is necessary to achieve the same effect (e.g., pain control, or getting high).

Dependency refers to the undesirable symptoms that arise when the medicine is suddenly stopped. These symptoms - called withdrawal - can be quite distressing, so the drug must be tapered gradually instead of stopping it suddenly. Both tolerance and dependency are common when narcotics are used for more than a few weeks. Some people are more susceptible than others and may experience these problems after just a few days. 

Addiction is a step beyond tolerance and dependency. When a person takes an action or engages in a behavior for the sole purpose of getting more of a medicine or drug, they are said to be addicted. Typically, these behaviors are inappropriate and often self-destructive.

The good news is that most people who take narcotics for pain control (rather than to get high) do not get addicted. They may have difficulty getting off the medication but they don't engage in harmful behaviors just to get more drugs. 

Because of the risk of addiction, narcotics are tightly controlled. The practical problem this creates for patients is that prescriptions for these medications can only be written for 30 (sometimes 90) days. Also, you must have the original prescription with the doctor's signature - it can't be called in or faxed to your pharmacy.

This means that you must stay in close touch with your prescribing physician because, if you run out of medicine, it may not be possible to refill the prescription immediately. If that happens, you may suffer from withdrawal symptoms at the same time that your pain gets out of control. 

The most common side effects of narcotics are sedation and constipation. Most people get used to the medicine and don't feel too groggy after the first week or two. The constipation, however, often requires a combination of treatments, including walking, more fiber in the diet, water, stool softeners, and laxatives. 

If you only need a narcotic occasionally, when the pain gets really bad, then just about any one of them is as good as any other. However, if you will be using it regularly, there are ways to maximize the benefits and reduce some of the risks.

Some narcotics are available in slow-release formulations that gradually enter your system. Releasing the drug slowly provides longer relief of pain and so avoids the problem of needing higher doses several times a day to regain pain control. In addition, slow-release versions are less likely to cause a "high" sensation, and so are less likely to place you at risk of addiction. 

For baseline control of pain, I usually prescribe either oral morphine or oxycodone in the slow-release forms, or fentanyl in a patch that is placed on the skin. For treatment of pain flare-ups,

I prescribe an immediate-release form of the same medication that can be taken by mouth as needed. The goal is to find a dose of the slow-release formulation that allows the patient to need, on average, one extra dose daily-including no extra pain medication some days or 2 or more extra doses on other days. 

One final caution: Even if you are using a narcotic responsibly for pain control, you still should remain aware that this is a drug of abuse. Therefore, having such medication, or even just a prescription for it, makes you a potential target of crime.

Tell as few people as possible that you are on it and always keep your medications safely locked up. If you are traveling, especially to another country, carry a copy of your prescription or a note from your doctor along with your medications.