why chronic narcotics make pain worse?

While narcotics are important and sometimes required for acute pain - such as postsurgical pain or pain after an injury - narcotics have not been found to provide long-term benefit in patients with chronic pain.  Narcotics can provide temporary relief, but they also have significant side effects.  The most important side effect of prolonged narcotic use has been identified through careful research.  Narcotics work by adjusting how the nerves work within the spinal cord so that those nerves do not transmit pain impulses to your brain.  Unfortunately, the same narcotics turn on a group of specialized cells called glial cells that are responsible for making these pain pathways-that are already activated- even more activated and making it more difficult for these pathways to be turned off. The use of narcotics for the management of chronic, non-cancer related pain triggers a cascade of events that typically makes it difficult for the patient to get off the narcotics and their pain much more difficult to resolve. There are many other ways to treat pain that do not contribute to a worsening or persistence of pain.  These include techniques of neuromodulation, SoLá pelvic therapy, non-narcotic medications (especially those that turn off nerve related pain) as well as behavioral interventions such as mindfulness straining.  I encourage you to speak with me or your other providers concerning options that do not include narcotics.