Nearly Eight Years on Opioids, and Pain No Better: What a Northwestern Brain Study Found

Imagine two people with the same back pain, sitting in the same waiting room. One has taken a daily prescription opioid for most of a decade; the other never started. Would you expect the first person to be in less pain? A study from Northwestern University set out to answer that question with brain scans as well as questionnaires — and the answer was not what many would guess.

What the researchers did

The team, led by senior author A. Vania Apkarian of Northwestern University Feinberg School of Medicine, compared 70 patients with chronic back pain who had been taking daily prescription opioids for an average of 7.8 years with 70 tightly matched patients who also had chronic back pain but were not taking opioids. According to the university’s announcement, participants in the opioid group were on low or moderate doses under medical supervision. Everyone completed measures of pain, physical function and emotional health and had functional MRI scans. The study appeared in the journal Brain on 1 October 2026 and was announced through EurekAlert!.

What they found

The two groups reported almost identical pain — about 5.4 out of 10. The opioid group did slightly worse on physical function and mental health. In the researchers’ words, years of opioid use did not seem to improve pain and functioning.

The brain findings had two sides. Reassuringly, the team found little evidence that long-term use had altered brain anatomy; Apkarian described the psychological and brain properties of the opioid group as “essentially intact”. But spontaneous brain activity — how regions function and communicate — differed strikingly between the groups, particularly in the mesocorticolimbic network, which is involved in reward and motivation, and in the prefrontal cortex, which supports decision-making.

Using a new computational method that combines MRI data with published maps of neurotransmitter receptors, the team also described molecular signatures linked to chronic pain and to long-term opioid use, involving serotonin and opioid receptors. In a smaller part of the study, 21 patients completed a four-week pain rehabilitation programme; eight reduced their opioid use by more than 30 per cent, and their brain activity changed in ways tied to those same receptor systems. Based on this, the group plans to test whether an antidepressant acting on the serotonin pathway could help treat chronic pain and support tapering.

Why it matters in everyday life

Roughly five million adults in the United States use prescription opioids regularly for chronic pain, the announcement notes. For many of them the question is not abstract: is this medicine still doing anything for me? This study adds careful evidence that, as a group, long-term users were not in less pain than similar people who had never started. It also offers something constructive — a biological lead on treatments that might help people who want to reduce their dose.

What this does not establish

• It is a comparison between two existing groups, not a trial. We do not know how the opioid group would have fared had they never taken opioids, or how the non-opioid group would have fared had they started. People who stay on opioids for years may differ in ways that matching cannot fully capture.
• Participants were on low to moderate, supervised doses. The results say nothing about higher doses or unsupervised use.
• The antidepressant idea is a plan for future research, not a treatment that has been shown to work.
• This study is not a reason to stop or cut a prescription on your own. Stopping opioids abruptly can cause withdrawal and other harms; any change should be planned with the prescriber.

Questions you might discuss with your clinician

• How are we measuring whether my current medicines are helping my pain and my function?
• If I wanted to reduce my dose, what would a safe, gradual plan look like, and what support is available?
• Which non-medicine options — physical therapy, pain rehabilitation, procedures — might be appropriate for my type of back pain?

Interventional options SEVA Healthcare lists for back pain are described on our Back & Neck Pain page. Whether any is suitable depends on an individual evaluation.

Frequently asked questions

Did long-term opioid use lower pain in this study?

No. Both groups reported almost identical pain, about 5.4 out of 10, and the opioid group did slightly worse on physical function and mental health.

Did years of opioid use change the brain?

The researchers found little evidence that long-term use had altered brain anatomy. However, spontaneous brain activity differed strikingly between the groups, especially in networks involved in reward, motivation and decision-making.

Should I stop my opioid prescription based on this study?

No. The study is not a reason to stop or cut a prescription on your own, because stopping opioids abruptly can cause withdrawal and other harms. Any change should be planned with the prescriber.

Is the antidepressant mentioned in the study a proven treatment?

No. Testing an antidepressant that acts on the serotonin pathway is a plan for future research, not a treatment that has been shown to work.

Sources

• Years of opioid use do not improve chronic pain, study finds — Northwestern University via EurekAlert!, 2026-10-01
• Baliki M, Vigotsky A, Rached G, et al. Multi-molecular adaptations of long-term opioid use in chronic pain — Brain, 2026-10-01
• Study DOI: 10.1093/brain/awag339

This article is sponsored content by SEVA Healthcare and is for general information only — it is not medical or legal advice. Treatment options depend on an individual evaluation, and results vary from person to person. In an emergency, call 911. Spotted an error? See our corrections policy.