Managing Chronic Pain in Addiction Treatment

Whether short-term acute pain or seemingly endless chronic pain, the result is the same while a person experiences it. Pain can interfere with daily activities, causing people to feel helpless and hopeless. Pain’s intensity varies depending on the cause, ranging from dull and nagging discomfort to severe pain with hard throbbing or stabbing sensations.

Chronic Pain in Addiction Treatment

Causes of Acute Pain and Chronic Pain

Acute pain has many causes, including broken bones, sprains and flesh wounds from sports injuries, vehicle accidents, falls, etc. Chronic pain often occurs due to conditions like arthritis, cancer or other long-term physical ailments. It doesn’t matter if it’s acute or chronic pain; people who suffer want pain relief. Pain medication is the typical treatment for acute or chronic pain.

Challenges of Pain Symptom Management

Depending on the intensity of pain, individuals may get pain relief from over-the-counter or prescription medications. However, some need a carefully crafted approach to pain management.

According to the U.S. Department of Health and Human Services, in 2019, over 10 million people aged 12 and older abused opioids. The Centers for Disease Control estimated that overdose deaths increased from 56,064 to 75,673 in the 12 months ending April 2021. Opioid addiction often starts when people take opioid-containing prescription drugs to deal with pain. Some people develop drug tolerance, which means it takes more of the drug to make them feel better, leading to abuse. When a health care provider stops prescribing pain medication due to concerns about abuse, some people turn to more potent drugs like fentanyl. In desperation, many seek drugs from dangerous illegal sources.

People who struggle with substance abuse and opioid addiction face challenges when dealing with acute pain or chronic pain. While they deserve and need to relieve pain, it’s often challenging to control pain because of the risk of opioid dependence. Some individuals in substance abuse treatment programs suffer from chronic pain, and they also deal with unpleasant withdrawal symptoms that cause additional pain and sickness. Without adequate pain relief, they endure the difficulty of stopping drug use and feeling miserable physically. Opioids may be the answer for many people, but for individuals with substance use disorder, prescribing opioids for pain management can spell disaster.

Opioids and the Brain

Opioids include fentanyl, heroin, hydrocodone, codeine, morphine and other drugs. The highly addictive nature of opioids makes them a risk for anyone needing pain medications. Using opioids to manage pain can lead to addiction due to the drug’s effect on the brain’s pleasure center.

Endorphins, the naturally occurring pain relievers in the brain, are usually not enough to control severe pain, so the primary care physician or specialist may prescribe opioid analgesics for short-term pain relief.

Chronic pain management requires medication that can provide adequate pain control that enables individuals to function and go about their daily routines. However, opioids can rewire the brain. Opioids bind to nerve cell opioid receptors and offer pain control, but they also provide a feeling of euphoria, and this pleasurable experience can lead to opioid addiction.

Opioid-dependent patients struggle when they enter addiction recovery programs because if they experience pain, opioid therapy may not be an option, which means they may not get adequate pain control. Also, when an individual addicted to opioids stops taking the drugs, they may experience withdrawal syndrome. Withdrawal can be especially tough for patients with psychiatric comorbidities. Pain management for recovering addicts requires understanding individual struggles and needs

Pain Management for Opioid Addicts

Addicts who struggle with opioid medications can get relief from non-opioid pain medications during addiction treatment. In addition to non-opioid medications, health care providers may prescribe other non-opioid treatment options.

Non-Opioid Medications and Treatments

Some people get pain relief from over-the-counter non-opioid medications. These include aspirin, acetaminophen and the non-steroidal anti-inflammatory drugs ibuprofen and naproxen. For people with chronic conditions like arthritis or pain that originated with a sports injury, these medicines can be a solution for managing pain. For individuals experiencing localized pain, creams, gels, lotions, patches and ointments can provide pain relief.


Some people also find acupuncture helpful. The technique has shown promise in treating arthritis, headaches and back pain.

Nerve Blocks

Nerve blocks alleviate pain through injections that numb the nerves in pain-prone areas. The health care provider inserts a small pump under the skin to treat pain. The pain pump works by delivering medication to the nerves and spinal cord.

Physical Therapy

Physical therapy addresses musculoskeletal issues, neurological conditions such as multiple sclerosis and stroke and sports injuries. A physical therapist may prescribe exercises the patient can do between appointments or after completing the recommended visits.

Radiofrequency Therapy and Electrical Nerve Stimulation

Radiofrequency therapy and transcutaneous electrical nerve stimulation treat acute and chronic pain with low-voltage electrical currents that block the transmission of pain signals.

Opioid Substitution Therapy

Opioid Substitution Therapy

Individuals addicted to opioids typically need medication to help when they experience withdrawal symptoms. Opioid substitution therapy is an addiction medicine option for individuals in rehab to stop using opioids without having a difficult withdrawal. This medically assisted treatment uses methadone and buprenorphine to help individuals deal with withdrawal from opioids. These treatments don’t get a person high — the opiates bind to opioid receptors but aren’t as addictive as the traditional opioid medicines. When taking these medications as prescribed, patients feel normal while detoxing from opioids.

Supplemental therapies like tai chi, yoga and meditation can be helpful. The patient can practice them easily outside an inpatient rehab program. Any of these activities can become part of a healthy lifestyle.  Pain management should help people get relief on the lowest dose of medication possible. The patient and health care provider must work closely to determine what’s necessary to relieve symptoms. A numeric rating scale is easy to understand and one way to assess pain levels and help individuals get some relief.

It’s best that only one health care provider prescribes pain medications. People who see several specialists for health issues may get different pain medications. There are others who “doctor shop” when they get desperate for drugs. Electronic monitoring systems in many states allow prescribers to see whether other health care providers have prescribed potentially addictive medications to patients.

Whether an addicted person needs help with moderate pain or acute pain management, help is available to treat pain while overcoming opioid addiction. Treatment centers can combine behavioral therapy with medically assisted treatment as well as other therapies. Using creative and practical approaches to help individuals detox from opioids without painful withdrawal symptoms allows them to be more successful in addiction treatment by focusing on recovery goals rather than opioid cravings.