Q. Years ago I was trapped in a vicious rebound headache cycle from taking narcotics almost every day. I had to endure painful withdrawal to stop those drugs. Today I am better, but I will soon need back surgery. I am scared to use narcotics again. What else can I use for pain?


A. First and foremost, please speak with your surgeon prior to your surgery to communicate your expectations and fears regarding pain. This conversation can help ensure that your pain-control needs are properly met.

Your question noted a key piece of information—the fact that you were taking narcotics “virtually every day.” Furthermore, I suspect that this situation had been occurring for many months, if not years, since most rebound headache sufferers have endured their condition for prolonged periods of time. I would argue that you could use narcotics after your surgery, particularly in the days or even the first few weeks after your procedure, which is the time when you are most likely to need narcotics. After that time, the pain is typically either gone (and the narcotic stopped) or decreased enough that non-narcotic drugs are effective.

To avoid a return to the problems you experienced during your rebound headache cycle, you will want to avoid using daily or almost-daily narcotics for consecutive months. If you find yourself moving toward that situation, speak with your healthcare professional. Another non-narcotic option for postoperative pain is ketorolac, which is an injectable, anti-inflammatory medication.

Richard Wenzel, PharmD
Presence Healthcare — Saint Joseph Hospital
Chicago, IL