When Chronic Pain and Opioid Dependence Overlap: Treating Both

Pain changes the equation. When chronic pain and opioid dependence exist at the same time, treatment has to account for both problems because focusing on one while ignoring the other can leave a person caught between uncontrolled symptoms and the risks of continued opioid use.

This is more common than many people realize. Someone may have started taking hydrocodone, oxycodone, or another opioid because of an injury, surgery, back problem, or another painful condition, and over time found that stopping the medication brought withdrawal, cravings, or a loss of control that was never part of the original plan.

The overlap between chronic pain and opioid dependence

The distinction matters. Physical dependence can develop when the body adapts to regular opioid exposure, while opioid use disorder involves a broader pattern of problematic opioid use that can include cravings, difficulty controlling use, and continued use despite harmful consequences.

Pain can complicate both. A person may be afraid to reduce opioids because they expect their pain to become unbearable, while also recognizing that the medication has become difficult to control or that they are experiencing withdrawal when they try to stop.

That fear is understandable. The clinical challenge is finding a treatment plan that recognizes the reality of the pain while also addressing opioid dependence or opioid use disorder in a medically appropriate way.

The CDC's guidance on opioid use disorder and pain management recommends that people with co-occurring pain and OUD continue to receive pain management while clinicians consider nonpharmacologic and non-opioid approaches as appropriate; for people with active OUD who are not yet receiving treatment, the CDC notes that buprenorphine or methadone treatment can also help with concurrent pain management.

Why treating only one problem can leave the other behind

Pain does not disappear because someone has developed opioid dependence. Neither does opioid dependence disappear because the original pain was legitimate.

Both need attention. A physician evaluating this situation may look at the cause and pattern of the pain, current medications, opioid history, withdrawal symptoms, cravings, other medical conditions, sleep, mood, and how pain is affecting everyday function before deciding what treatment makes sense.

The goal is not simply to replace one medication with another. It is to create enough stability that the person can address the underlying pain while receiving appropriate treatment for opioid use disorder.

That may mean medication management alongside other approaches to pain. Depending on the individual and the cause of the pain, those approaches can include physical therapy, behavioral strategies, exercise or movement-based treatment, non-opioid medications, sleep support, and care from other medical professionals.

Where buprenorphine may fit

Buprenorphine is a medication used to treat opioid use disorder, and it can be an important part of treatment when chronic pain and opioid dependence overlap.

It is not a universal answer. The right medication and treatment plan depend on the person's medical history, opioid exposure, pain condition, current symptoms, and other factors that need to be evaluated by a physician.

Research is encouraging but not unlimited. A 2024 review of care for people with co-occurring chronic pain and opioid use disorder found evidence supporting opioid agonist treatments such as buprenorphine and methadone, while also emphasizing that people with both conditions often need a combination of pharmacologic and nonpharmacologic strategies.

Other research has looked specifically at transitioning people from long-term opioid therapy to buprenorphine. A systematic review published in JAMA Network Open found that available evidence suggested buprenorphine rotation could be associated with maintained or improved pain outcomes, but the researchers also described the overall evidence as low quality and noted important limitations.

That distinction matters. Treatment should be based on the person in front of the physician, not on the assumption that one medication will solve every aspect of chronic pain.

What comprehensive treatment can look like

Good treatment starts with a full picture. If chronic pain is part of your history, it should be part of the conversation when you seek treatment for opioid dependence rather than something you are expected to leave at the door.

At Addiction TeleMD, Dr. Kevin Passer considers co-occurring concerns such as chronic pain, anxiety, depression, and sleep disturbances when developing an individualized treatment plan. The practice provides Suboxone prescription and management through telemedicine for eligible patients in California and Mississippi.

The medication is only one part of the work. Ongoing appointments provide an opportunity to discuss cravings, withdrawal, medication response, pain concerns, and changes in your circumstances so that treatment can be adjusted when appropriate.

This is especially important when pain has been part of your opioid history for years. A treatment plan should recognize what the medication was originally doing for you while also addressing what has changed since then.

Starting Suboxone when chronic pain is part of the picture

Starting buprenorphine requires care. Timing matters because buprenorphine can displace other opioids from receptors, which can cause precipitated withdrawal if treatment is started under the wrong circumstances.

That does not mean you should try to manage the transition by yourself. Addiction TeleMD explains the induction process in its guide to your first Suboxone telehealth visit, including why the timing of the first dose matters.

The issue can be more complicated for someone who has been taking opioids for chronic pain. The medication, dose, duration of use, and other substances involved all matter when determining how treatment should begin.

Fentanyl can add another layer of complexity. TeleMD's discussion of precipitated withdrawal and Suboxone induction explains why physician-guided timing and an individualized induction plan are important.

You do not have to choose between treating pain and treating dependence

Chronic pain deserves to be taken seriously. So does opioid dependence.

When the two overlap, the answer is not to ignore the pain, and it is not to assume that continuing the same opioid regimen is the only way to manage it. A thoughtful treatment plan considers both conditions and looks for ways to improve safety, stability, and day-to-day functioning without reducing your experience to a single diagnosis.

If chronic pain has become part of your opioid dependence story, you can start with a conversation about what you have been taking, why you started, what happens when you try to reduce it, and what you want treatment to look like.

There is no need to decide everything today. You can contact Addiction TeleMD to discuss your situation with Dr. Kevin Passer and explore whether physician-guided Suboxone treatment is appropriate for you.