Often, the pain can be abated with a program of medications, therapies, and support; narcotics are often a key part of this program, and sometimes at high doses.  I have treated high-functioning people with very high doses of narcotics, which have allowed them to continue to have a life, both personal and work.  The side effects can be severe, and the narcotics are only a part of a much larger program involving exercise (absolutely critical!), treatment of depression (always present, and acting like an amplifier for the pain), any therapies that work (manipulation, acupuncture, massage, physical therapy), and probably a lot of other medications to help treat the pain.  

The goal in treating chronic pain is not to take the pain away.  We all have some pain, and the only way I can take it away is to change my name to Kevorkian.  The question is, how are you functioning?  Are you able to live your life?  Are you able to do more?  If not, even if you have no pain, the treatment is ineffective.  The pain treatment is to keep the the pain from preventing sleep, interfering with work, interfering with relationships, getting in the way of a spiritual life, stopping exercise, and so on.

One of the side effects of narcotics is that the body gets used to it being around.  Physical dependency is not addiction.  I see the body get used to the presence of decongestants, or blood pressure drugs, or echinacia, and have to adjust to not having the drug around; this happens with narcotics in a most nasty way.  This happens any time someone is on these drugs at high doses for any prolonged time.

Another side effect, unfortunately, is that these drugs can feel pretty darned good, not just physically.  It seems some people are more prone to the euphoric effects of narcotics.  This is where addiction comes in, and there doesn't even have to be a lot of physical dependence.  What happens is that the drug feels a little too good, you want more, you crave more, you have to have more.  Depending on how deep you get, you may find yourself doing things you never could have imagined to get the drug, like stealing from a good friend.  Welcome to hell.

Causing addiction is probably the worst fear of most doctors in treating chronic pain.  There are other fears - that the drugs will be diverted for profit, that the patient will die from an overdose, that the doctor will face a legal inquisition from either malpractice lawyers, or from government regulators - or even from prosecuting attorneys.  There is a culture that "drugs are bad", that prescribing a lot of narcotics is suspect.

The other, too common aspect is drug seeking and drug diversion - basically, people bluffing their way to a prescription of feel-good narcotics.  Our clinic policy is to put people in jail if we catch them lying to obtain a prescription for drugs.

These fears, the lack of knowledge of pain management by most physicians, the remarkable amounts of time required to do a good job in pain management, and the plethora of people out there looking to score some good stuff for cheap with a prescription, all make it so most doctors just aren't willing to deal with chronic pain.  It isn't worth it to them.  And you can't blame them.

There is no easy answer to the treatment of pain with drugs that are addictive and have a high street value.  The creeps that abuse the system make it a lot harder for the people with real pain, with real pain needs, to get the treatment that will allow some semblance of a life.  And even in the wisest, most compassionate hands, these drugs can on occasion lead to addiction.  This happens rarely, but even once is a tragedy.