Back pain people with severe back pain will need narcotics oh that’s a that’s a bad one I’m glad you asked that question look let’s say you wake up and pain you take an hour quartic it’s gonna make you feel better and then the next day comes and you wake up and pain again you take another one you take another one and what if a third day comes is that today when you’re gonna say nah today I feel like being in pain that day never happens you just continue taking narcotics I’m sure you were just dependent on him you got it withdrawal tolerance and dependence happens with absolutely everyone I tell my patients this real sad story about my teachers or my professors sisters who was an orthopedic surgeon quite an ankle sprain an ankle sprain and she had to go to work so she started taking narcotics and she committed suicide about ten years later because ten years she couldn’t get off narcotics and this is a physician that’s a person who knows the risks of taking narcotic pain medication narcotics are reasonable there’s a fracture because the fracture will get better narcotics are reasonable after surgery because the surgical pain will reliably and quickly get better narcotics are absolutely contraindicated not a good idea for chronic low back pain now doc I only have two three days of back pain how do you know if it’s chronic we don’t know we got now which is why my main message is that you gotta have a diagnosis if you know that this is something no big deal okay it’s reasonable to take two or three days of narcotics not my favorite way of treating problems but it’s not unreasonable that’s play medicine if this is something that’s not gonna go away if you don’t have a clear idea that this is self-limited or this is going to be something corrected a week from now with a surgical intervention don’t take narcotics so do you rep do you prescribe narcotics after a surgery for any of your patients sure – that’s it that’s it I mean they can have more for a bigger operation I mean I’m a human being right but still with a with a surgical intervention there’s gonna be surgical pain but that pain is self-limited right it goes away it will go away quickly not enough time to develop tolerance withdrawal or dependency on the narcotics