Do You Really Need Back Surgery? A Surgeon's Guide to Neck and Back Pain and How to Choose Your Treatment

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Table 3 - Narcotic Pain Medications
Class Name Chemical name Risks
DEA Schedule III - Narcotic Compounded Medications Standard Prescriptions
Tylenol#3 codeine, Tylenol A1, LT
Empirin codeine, aspirin A1, GI
Vicodin, Lorcet, Norco hydrocodone, Tylenol A1, LT
Vicoprofen hydrocodone, ibuprofen A1, KT, GI
Darvocet propoxyphene, Tylenol A1, LT
Darvon propoxyphene, aspirin A1, GI
DEA Schedule II Narcotic Compounded Medications Triplicate or monitored prescription
Percocet oxycodone, Tylenol A2, LT, WI
Percodan oxycodone, aspirin A2, GI, WI
DEA Schedule II Narcotic Medications Triplicate or monitored prescription
Dilaudid hydromorphone, tablet A3, MC, RD, WI
Duragesic Fentanyl patch (q3 days) A3, MC, RD, WI
Actiq Fentanyl oral swab - rapid action A3, MC, RD, WI
Oxycontin oxycodone, slow release tablet (q12hr) A2, MC, RD, WI
Oxy-IR oxycodone, fast release tablet A2, MC, RD, WI
Demerol meperidine, injection or tablet A3, MC, RD, WI
Kadian morphine, sustained release capsule (q12hr) A2, MC, RD, WI
MS Contin morphine, slow release tablets (q12hr) A2, MC, RD, WI
Avinza morphine, extended release capsule (q24hr) A2, MC, RD, WI
Table 3 - A listing of representative types of narcotic pain medications. In general all of these medications includes a natural or synthetic analog of the opium substance from the opium poppy. All of these mimic a natural body chemical called an endorphin. They relieve pain in a variety of ways but have a risk of addiction and of dependence that can lead to needs for progressively higher doses.

All pain medications listed in the text and table of this site have side effects. In addition to those listed as special risks for each of these medications, there are serious but unusual side effects that occur rarely such as decreased production of blood cells by the body. All medications are risky for anyone who may be pregnant or who is breast feeding and require special attention before prescribing. With the exception of over-the-counter drugs, all of these medications should only be taken with a prescription for the patient and under the direction of a physician. Liver toxicity and kidney toxicity usually do not occur, but routine blood tests for signs of these problem are essential if they are taken on an ongoing basis. Narcotic drug dependency, addiction, and potiential for abuse are risks that can be controlled and monitored but are always a consideration when these medications are prescribed.

(A1) – some addiction potential; (A2) – significant addiction potential; (A3) – high addiction potential (GI) – gastric irritation; (KT) – kidney toxicity; (LT) – liver toxicity; (MC) – mental clouding; (RD) respiratory depression;  (WI) – withdrawal risk.
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Aaron Filler, MD, PhD Do You Really Need Back Surgery Spine illustrations Oxford University Press Spine Book table of contents
Back Pain Guide