Chronic Pain and Addiction Recovery

Getting Help for Pain While Protecting Recovery

Chronic pain is pain that lasts more than three months. It can interfere with sleep, movement, work and relationships. If you also have concerns about substance use, both needs deserve attention. The Centers for Disease Control and Prevention (CDC) specifically advises ongoing pain care for people who have pain and opioid use disorder.^[1][2]

You may be worried that asking for pain relief will be mistaken for seeking drugs, or that accepting medication could threaten your recovery. Bring those concerns into the conversation. A useful starting question is: “How can we treat my pain and support my recovery in the same plan?”

If someone cannot be awakened or is breathing slowly after possible opioid use, give naloxone if available and call 911. Stay with them until help arrives.^[3] Do not abruptly stop or rapidly reduce prescribed opioid pain medicine without speaking with a healthcare professional.^[4]

Pain, Physical Dependence and Addiction Are Different

These terms answer different questions. Physical dependence means the body has adapted to a medicine and withdrawal symptoms can occur when it is reduced or stopped. Tolerance means the same amount produces less of an effect over time. Both can happen with prescribed opioids.^[1]

Opioid use disorder is a pattern of opioid use that causes significant problems. A clinician looks at the whole pattern, including difficulty controlling use, cravings, missed responsibilities and continued use despite harm. Tolerance or withdrawal during appropriate medical treatment does not, by itself, establish this diagnosis.^[5]

For example, telling a prescriber that pain has returned before the next dose is information they need to assess. It is not a diagnosis. Tell them what you are taking, what the medicine helps with, what worries you and whether you have taken it differently from the prescription. That gives the appointment a clearer starting point.

If you are concerned about prescription opioid addiction, ask for an assessment alongside pain care. You do not have to decide on a label before asking for help.

What a Combined Pain and Recovery Plan Can Include

A combined plan identifies the cause of pain where possible, considers your health and substance-use history, and sets goals you can recognize in daily life. It may include more than one kind of treatment. The U.S. Food and Drug Administration (FDA) recommends an approach that combines treatments and reassesses their benefits and risks over time.^[4]

The roles below overlap, but they are not interchangeable. Use the questions to clarify what a service actually offers.

Nonopioid pain management is a set of options, not one treatment. It can include physical approaches, psychological therapies and medicines such as anti-inflammatory drugs or selected antidepressants. The choice depends on the type of pain and your other health needs. Kidney, liver, stomach or heart conditions can affect medication safety.^[6]

Ask what a recommended treatment is intended to change. Is the goal less pain, walking farther, sleeping better, returning to an activity or reducing a medication side effect? Agree on how and when you will review that goal.^[1]

How Therapy Can Help With Chronic Pain

Cognitive behavioral therapy (CBT) for chronic pain helps people work on the thoughts, feelings and activity patterns that affect living with pain. A therapist might help you plan manageable activity, respond to frightening thoughts about pain, or communicate your needs. The aim includes improving daily life and coping, rather than promising to cure the pain.^[7]

In a 2018 Stanford Medicine interview article, pain psychologist Beth Darnall described assessing sleep, physical activity, mood and social life, rather than relying only on a pain score. That offers a useful way to prepare: describe what pain prevents you from doing, as well as how much it hurts.^[8]

For instance, “I cannot sit through dinner with my family” gives you and a clinician a concrete activity to discuss. A plan might focus on making that activity more manageable. This is an example of setting a goal, not a prediction that any particular treatment will achieve it.

Benefits also need realistic expectations. In Cochrane’s 2020 interview about her review, psychologist Amanda Williams emphasized that talking therapies differ and require appropriate training. She described small improvements in disability and distress with CBT, with uncertain findings for some other approaches. This supports asking about the specific treatment offered rather than assuming all counseling addresses pain in the same way.^[9]

Tell the therapist if sessions increase distress or the activities are not manageable. Discuss adjusting the work, changing the pace or whether another approach would fit better. A pain psychology service should review your goals and progress with you.^[7]

Taking Pain Medicine During Addiction Recovery

Medication decisions should be individualized. A history of addiction is important information for planning care, but it does not answer every question about pain treatment. The FDA warns both about opioid harms and about harm from abruptly stopping opioids in someone who is physically dependent.^[4]

Take prescribed medicine as directed. If pain is worsening, a medicine seems less effective or you are worried about running out, contact the prescriber or pharmacist. Explain the problem and ask what to do next. Do not increase the dose, borrow someone else’s medicine or make a sudden change yourself.^[4]

If You Take Medication for Opioid Use Disorder

Tell the pain clinician which medicine you take and who prescribes it. CDC guidance notes that buprenorphine or methadone treatment for opioid use disorder can also help with pain. That does not mean your existing treatment covers every pain problem. Ask the clinicians to agree on a plan that addresses both conditions.^[2]

Before a planned operation or dental procedure, ask who will coordinate with your addiction-treatment prescriber. Write down whom to contact afterward if pain is not controlled, instructions conflict or you cannot obtain a prescription. Do not assume that stopping your usual medicine is part of the plan. Get instructions from the clinicians responsible for your care.

Ask About Interactions and Overdose Prevention

Give the clinician and pharmacist a complete list of medicines and substances you use. Combining opioids with alcohol, benzodiazepines or other medicines that slow the nervous system can increase overdose risk. The FDA’s 2025 warning also identifies gabapentinoids, a group that includes gabapentin and pregabalin.^[4][10]

Ask how to get naloxone, how to use it and where to keep it. If you choose, involve someone who may be with you in an emergency. Naloxone reverses an opioid overdose, but emergency help is still needed. If an overdose is suspected, give naloxone if available, call 911 and stay with the person.^[3]

Questions to Take to a Pain or Addiction Appointment

A written note can help you cover pain, recovery and practical barriers in the same visit. The questions below are a planning aid. You can choose the ones that match your situation.

Bring medication names and instructions, your allergies, previous treatments and what happened with them. Include alcohol, supplements and nonprescribed substances in the discussion. A clinician needs that information to assess interactions and treatment risks.^[4]

You could say: “My back pain is keeping me from sleeping. I am also worried about returning to opioid use. I want help with both. Can we review my medicines and decide who I should call if pain gets worse?” This is suggested wording you can adapt, not a real patient’s testimony.

Finding Chronic Pain and Addiction Care Near You

Start with a primary care clinician or the professional already treating your pain or addiction. Ask for help finding a pain service and, if appropriate, a therapist trained in chronic pain. Your insurer’s directory can identify participating providers, while state or county agencies can help identify mental health and substance-use services.^[11]

When searching for a chronic pain therapist near you, try terms such as “pain psychologist” or “CBT for chronic pain” with your town or state. Then verify the service directly. A search result or a general therapy profile cannot tell you whether the clinician treats your combination of needs.

Before booking, ask:

• Do you work with people who have both persistent pain and substance-use concerns?
• What pain-focused treatment do you offer, and what training do you have in it?
• Can you communicate with my other clinicians if I consent?
• Are you accepting patients, and do I need a referral?
• What are the charges, insurance requirements and cancellation rules?
• Can appointments accommodate difficulty sitting, walking, hearing, communicating or using video?

If you do not have insurance, community health centers and state mental health or substance-use agencies can help you look for affordable care. The Substance Abuse and Mental Health Services Administration lists these routes, along with FindTreatment.gov. Ask the specific service about eligibility and costs.^[12]

Treatment access options can help you think through cost, transportation and appointment barriers. Tell a service what would make the appointment possible, rather than assuming you must manage every barrier alone.

Can Online Therapy Help With Chronic Pain?

Some pain-focused psychological treatment is delivered online. Cochrane’s 2023 evidence summary found small short-term benefits from online CBT compared with usual care, but those benefits were generally not maintained at follow-up three to twelve months later. Evidence about unwanted effects was limited.^[13]

The review largely concerned internet programs with limited clinician contact. It does not establish that every live-video therapist or commercial therapy platform offers the same treatment or results. Ask about pain-specific skills, clinician involvement, follow-up and how the service will coordinate with medical care.^[13]

For online treatment options, also confirm that the provider can treat you where you will be physically located, what equipment and privacy you need, and whom to contact if the connection fails or urgent help is needed. A remote appointment needs a practical plan just as an in-person visit does.^[14][15]

When Your Pain and Recovery Plan Is Not Helping

Describe what is happening as specifically as you can: pain that prevents a particular activity, unwanted effects, cravings, unaffordable appointments or treatment you cannot physically manage. Ask which part of the plan needs reassessment and whether another professional should be involved. Ongoing review is part of pain care.^[1]

If you feel dismissed, ask the clinician to explain their assessment and next steps. You can also seek another opinion. For therapy, the National Institute of Mental Health recommends discussing concerns when treatment is not helping and considering a different provider or type of treatment when needed.^[11]

You can explore addiction treatment approaches or find treatment help while asking your existing clinician to address the pain problem. Bring the appointment questions with you so the conversation covers both needs.

For suicidal thoughts or emotional distress, call or text 988. For a life-threatening emergency, call 911.^[11]