Most of us have reached for a pill when the back acts up. For people whose back pain never really goes away, that quick fix often turns into a daily habit that stretches on for years.
The question has long been whether the drugs are still doing their job after that much time.
A new study, published October 1, 2026 in the journal Brain, says the answer is no.
Researchers at Northwestern University compared two groups of chronic back pain patients.
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The first had been on daily prescription opioids for nearly eight years. The second had never used the drugs.
Each group included 70 people. Both reported pain at around 5.4 out of 10.
The long-term opioid users also scored slightly worse on physical function and mental health than the matched group. After years of pills, there was no measurable pain benefit.
What the brain scans actually showed
The team scanned the participants' brains to look for signs that long-term opioid use had reshaped the brain.
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They found little evidence that years of opioid use had altered its anatomy.
The study was led by A. Vania Apkarian, director of the Center for Translational Pain Research at Northwestern University Feinberg School of Medicine.
"The psychological and brain properties of the participants on long-term prescription opiates were essentially intact," Apkarian said in a Northwestern University statement. But the pain, he added, had not improved after years of use.
The study did reveal what had changed. Activity patterns in brain networks tied to reward, motivation and mood differed sharply between the two groups.
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The team also mapped molecular markers linked to serotonin receptors and the brain's own opioid receptors.
In a smaller group that joined a four-week pain rehabilitation program, several patients managed to reduce their opioid use, and their brain markers shifted along with the change.
What this means for people living with chronic back pain
Treatment guidelines have been moving in this direction for years. The 2022 opioid prescribing guideline from the CDC says non-opioid approaches are at least as effective as opioids for many kinds of pain, including low back pain.
The American College of Physicians recommends that chronic low back pain be treated first with non-drug options.
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Those include exercise, mindfulness-based stress reduction, yoga, tai chi, cognitive behavioral therapy and spinal manipulation.
The new findings do not mean every long-term user should stop their medication on their own.
Stopping opioids suddenly can be dangerous, and anyone considering a change should speak with their doctor about tapering and alternatives.
The Northwestern team now plans to test an antidepressant that targets the same serotonin pathway identified in the brain scans.
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The goal is to see if it can ease chronic pain and help people trying to cut back on opioids.
This article is made and published by Mie Hermansen, who may have used AI in the preparation.