Chronic pain is a complex and long-lasting health condition that is experienced by millions of people worldwide. Acute pain is felt until the healing is complete, chronic pain persists long after any identifiable injury has healed for months or years, and manifests as a physical experience but also psychologically impacts your emotional side as well. Chronic pain patients may be prescribed opioids when traditional forms of pain relief have failed.Â
Opioid medications such as morphine can provide substantial relief for acute pain for a short period of time; however, a substantial hidden risk of taking opioid medication is developing substance use disorder (SUD) in the future. This blog entry explains the fine line between pain relief and addiction and highlights why involvement from a mental health clinic or addiction treatment center is often necessary to treat these complex cases.
Is Chronic Pain and Why Is It Difficult to Treat?
Chronic pain is typically described as pain which persists longer than 3-6 months after the initial injury or illness has healed. Examples of chronic pain conditions are arthritis, fibromyalgia, neuropathy, or chronic back pain. These are often difficult to diagnose using traditional methods, do not always have apparent physiological indicators, and respond differently to treatment. The treatment of chronic pain should be tailored on an individual basis.
The Emotional and Psychological Effects of Chronic Pain
Chronic pain not only has physical effects, but also far-reaching effects on a person’s mental health. Many patients will struggle with depression, anxiety, and insomnia as a result of continued pain. These emotional responses can also heighten the experience of pain, create a cycle of suffering, and are often connected to the cycle of emotional suffering & pain when they are able to recognize this cycle.Â
Research suggests that chronic pain can interfere with how your brain functions, and how you regulate emotions, creating a series of neurological coordinates that also overlap with rates of drug addiction and substance use & abuse. In many instances, the untreated emotional stress pushes chronic pain patients towards medication misuse without even realizing what they are doing.
Opioids in Pain Management: A Double-Edged Sword
Why Opioids Are Commonly Prescribed
Opioids are frequently prescribed when other treatments don’t work. These narcotics work by binding to opioid receptors in the brain and spinal cord, changing the way pain is perceived. For short-term pain relief, they can be effective, but extended use increases the risk of substance disorder.
The Long-Term Risks
Long-term opioid therapy often leads to tolerance, where the same dose no longer works, and patients may start increasing the dosage. This can result in physical dependence, withdrawal symptoms, and in extreme cases, opioid use disorder (OUD). Studies show that continued opioid use rarely improves function or pain control in chronic conditions—and may even result in fatal outcomes if substance use disorder goes unrecognized.
How Substance Abuse Develops in Pain Patients
The Silent Onset of Dependence
Dependence on a substance usually does not occur intentionally. Addiction started with a legal prescription to treat legitimate pain. Over time, these patients have perhaps even unwittingly but continue to misuse medication by increasing the frequency or dose in an attempt to avoid withdrawal symptoms. Over time, some patients may end up addicted to a substance, as their goal is pain relief, not substance misuse.
The Challenge of Identifying Hidden Addiction
The signs and symptoms of drug use addiction and withdrawal, such as fatigue, irritability, confusion, can easily mimic chronic pain. This can make it easier for the patient and the provider to not recognize that addiction is occurring.Â
Many patients struggle with the stigma of substance misuse and addiction, and may put off discussing changes in medication habits, which can delay availability for offers for diagnosis and treatment. If the patient’s pain management is not closely followed, dependency may go easily unnoticed until we reach a crisis level for dependence or addiction.
Red Flags: Spotting Opioid Misuse in Chronic Pain Patients
Behavioral Signs
- Requests for early refills
- Visiting multiple doctors (doctor shopping)
- Claims of lost or stolen prescriptions
- Resistance to dose reduction or non-opioid therapies
Physical and Emotional Warning Signs
- Agitation, confusion, or increased anxiety
- Withdrawal symptoms between doses
- Refusal to undergo drug screening
- Visible signs of intoxication during checkups
If these signs are present, it’s crucial to involve a mental health clinic or refer to an addiction treatment center for immediate evaluation.
Safer Alternatives to Opioids for Chronic Pain
Non-Pharmacological Treatments
Several non-drug therapies can effectively manage chronic pain:
- Cognitive Behavioral Therapy (CBT)
- Physical therapy and rehabilitation
- Acupuncture and chiropractic care
- Mindfulness and meditation techniques
These methods help address both the physical and emotional sources of pain, reducing reliance on narcotic medications.
Non-Opioid Medications
- NSAIDs (nonsteroidal anti-inflammatory drugs)
- Antidepressants for nerve pain
- Anticonvulsants for neuropathic pain
- Topical treatments like lidocaine patches
- Localized nerve blocks
These alternatives are especially useful when integrated into a broader care plan that includes psychological support.
When Chronic Pain and Addiction Collide: Role of the Psychiatrist
Addressing Co-Occurring Conditions
When substance use disorder coexists with chronic pain, it becomes a dual diagnosis issue. In such cases, care must address both the physical pain and the addiction. A psychiatrist specializing in pain management and addiction can differentiate between true pain signals and signs of medication misuse.
Psychiatric Interventions
Psychiatrists offer:
- Medication-Assisted Treatment (MAT) like Suboxone or Methadone
- Trauma-informed psychotherapy
- Risk assessment for addiction and mental health concerns
- Coordination with pain specialists and mental health clinics
Such interventions are often conducted at addiction treatment centers, offering integrated and ongoing care for patients at risk.
Preventing Opioid Dependency in Chronic Pain Patients
Establishing Boundaries and Agreements
Clear opioid prescribing protocols are essential. Physicians should only prescribe opioids for short-term use and document treatment goals clearly. Creating an opioid treatment agreement helps set expectations and outlines the risks of misuse.
Ongoing Monitoring and Early Action
States now require Prescription Drug Monitoring Programs (PDMPs) to help track opioid prescriptions across providers and pharmacies. In addition, regular mental health screenings can detect signs of substance use & abuse before they escalate.
By combining self-reported medication logs with mental health evaluations, healthcare professionals can spot warning signs early and shift patients to non-opioid alternatives or refer them to a mental health clinic or addiction treatment center.
Conclusion: A New Model for Safer Pain Management
Chronic pain and substance use disorder often exist side-by-side. Without proactive monitoring and compassionate care, pain management can unintentionally lead to addiction. However, by setting clear boundaries, utilizing non-opioid therapies, and involving psychiatric support, when necessary, we can shift from simply masking pain to truly promoting healing and long-term wellness.
