Many familiar narcotic painkillers, such as morphine, Percocet, Oxycontin, Demerol, Lortab, Vicodin, Codeine and Darvocet are effective at reducing or eliminating pain. The downside is that long-term use can cause physical dependency and potential withdrawal symptoms.

When you take a certain medication, your brain increases the number of receptors for that drug. At the same time, nerve cells in the brain stop functioning normally and your body stops producing its own natural painkillers (endorphins). Degeneration of nerve cells causes us to become dependent upon the external supply of drugs. Suddenly stopping the medication triggers withdrawal symptoms.

The longer you take narcotic pain medicines, and the higher the dose, the more you are at risk for withdrawal symptoms. Long-acting opiods, such as Oxycontin, release a steady level of medication, so patients can get by with smaller doses and therefore become less dependent. Short-acting opiods, such as Percocet, Tylenol #3 or Vicoden, deliver much higher doses and are best for short-term use.

Corticosteroids, such as Prednisone, and glucosteriods are another class of drugs that are also effective for controlling pain. These medications mimic cortisol, a hormone our adrenal glands naturally produce. Long-term use of steroid medications causes the adrenals to produce less cortisol. A fast drop in Prednisone, for example, can trigger symptoms of cortisol deficiency and produce withdrawal symptoms.

Some physicians recommend an alternative day schedule: a high dose of the drug one day, followed by a low dose the next and so on. Your body functions with less cortisol on the low dose, but the overall dose keeps your disease activity under control.

Fortunately, as uncomfortable as they may be, medication withdrawal symptoms are not fatal and generally don't last very long. Typical medication withdrawal symptoms include restlessness, sweating, running nose or eyes, tremors, and elevated heart rate or blood pressure.

The best way to minimize medication withdrawal symptoms is to taper off the drug gradually. For example, if you've been taking Prednisone for a month, take a month to stop taking it. This allows your body to resume normal functioning.

Your physician may prescribe a steroid-sparing agent-usually an immunosuppressant drug such as Rheumatrex, Imuran or Plaquenil-to manage your disease while you taper off corticosteroids.

If you must stop taking pain medications, do so under the supervision of your physician.