Chronic back and neck pain are the two most common health problem in a primary care physician consultataion. Althought first line treatment for chronic back and neck pain begins with acetaminophen and nonsteroidal anti-inflamatory drugs(NSAID) in the treatment guidelines; American Geriatrics Society and The National Institute for Health and Care Excellence recomment against using NSAID if possible. Because treatment will last longer in chronic patients, the long-term effects of the analgesics become more important. Opioids offer stronger analgesic potency without prostaglandin related adverse events. Opioid therapy may also be considered when patients have failed to achive benefit from other pain therapies, are unable to tolerate non-opioid analgesics or have severe, disabling pain. The risk of misuse and abuse must be kept in mind and some treatment strategies planned.