Chronic Pain Care During Opioid Recovery

If you live with chronic pain, the thought of entering opioid addiction treatment may bring a difficult question: “Will anyone still take my pain seriously?” You may worry that discussing pain will invite judgment, or that recovery will mean being expected to endure it without support.

At Avalon Malibu, we believe you deserve to be heard without having to choose between honesty about pain and honesty about substance use. Our approach to opioid addiction treatment emphasizes individualized care. A meaningful conversation about recovery should include what hurts, what matters to you, and how both pain and addiction will be addressed.

Can pain and opioid addiction be treated together?

Yes. Opioid use disorder changes the risks clinicians must consider, but it does not remove the need for pain care. Treatment planning can address both conditions at the same time. Some medications used for opioid use disorder, including buprenorphine and methadone, can also help with concurrent pain management, although a separate, individualized pain plan may still be necessary. The CDC’s guidance on opioid use disorder and pain management explicitly recognizes the need for ongoing pain treatment.

Medication used to treat addiction should not be confused with recovery failure. The FDA identifies buprenorphine, methadone, and naltrexone as approved treatments for opioid use disorder. These medications have different characteristics and clinical considerations; they are not interchangeable pain treatments.

The important question is not whether pain or recovery deserves priority. It is how the care plan will give appropriate attention to both.

What should pain assessment and treatment goals include?

Pain assessment should involve more than a number on a scale. Your description of the pain, its timing and location, what changes it, and its effect on daily life all matter. Pain care also considers physical health, sleep, emotional well-being, and functioning. The goal is not simply a lower pain score, but better quality of life and participation in meaningful activities, as described in the National Institutes of Health’s overview of pain assessment and treatment.

Questions you can bring into a care-planning conversation include:

• What do we understand about the cause of my pain, and what remains uncertain?
• How will previous evaluations and treatment experiences inform this assessment?
• Which changes in my symptoms would prompt another medical evaluation?
• How will we track pain, sleep, daily activities, and recovery together?

Goals should reflect your priorities. Perhaps you want to sit through a family meal, manage personal care more comfortably, or participate more consistently in treatment. These are examples to discuss, not expectations you must meet to prove that you are trying.

In our pain management approach, we emphasize the whole person and the importance of daily functioning. We believe functional goals should complement attention to suffering, never replace it.

What role can nonopioid approaches play?

Nonopioid pain care is not one treatment. Depending on the pain condition and a person’s health, it may involve several approaches with different purposes:

• Physical approaches: Physical therapy and appropriately adapted movement may address mobility, strength, and everyday functioning.
• Behavioral approaches: Cognitive behavioral therapy and mindfulness-based approaches may address coping, stress, and the ways pain affects daily life.
• Nonopioid medications: Certain topical treatments, anti-inflammatory medications, and medications from other drug classes have roles in particular pain conditions.

These are educational examples, not recommendations to begin a particular treatment. Nonopioid does not mean risk-free: medications can have side effects, interactions, or limitations related to other health conditions. The CDC’s overview of nonopioid pain therapies emphasizes matching care to the condition and the individual.

We do not view psychological support as a declaration that pain is imaginary. Nor should a nonopioid plan become a vague instruction to “just cope.” You deserve an understandable explanation of each part of the plan, what it is intended to address, and how its usefulness will be evaluated.

Does adding behavioral pain treatment guarantee better results?

No. Behavioral pain care may have a place in an individualized plan, but its benefits should not be overstated.

A randomized trial involving 200 people receiving buprenorphine who also had persistent pain found no overall advantage from adding a telehealth behavioral pain program over enhanced usual care in the primary analyses of treatment retention, pain, or substance-related outcomes; both groups improved. The finding concerns one program and comparison, not every form of behavioral pain care.

A broader VA evidence review of co-occurring chronic pain and opioid use disorder also found that evidence remains limited, with many studies constrained by small samples and methodological weaknesses.

For us, the practical lesson is humility: an additional service is not automatically a better service. We believe care should be evaluated by its relevance, tolerability, accessibility, and contribution to the person’s goals—not simply by the number of therapies offered.

How will addiction and pain clinicians communicate?

You should not have to reconcile conflicting instructions alone. When several professionals are involved, a clear plan should explain who coordinates care, who manages each prescription, and how changes are communicated.

The CDC’s clinical practice guideline for pain care emphasizes coordination with substance use treatment providers when opioids are prescribed. It also cautions against abruptly discontinuing or rapidly reducing prescribed opioids except in circumstances involving an imminent, life-threatening concern. Medication changes require individualized clinical oversight, not self-directed adjustments.

Useful coordination questions include:

• Who is my main contact when pain worsens or instructions seem inconsistent?
• With my permission, how will my clinicians share relevant information?
• Who will review the full medication list for interactions and overlapping prescriptions?
• How will pain care be coordinated if I need surgery, dental treatment, or emergency care?

We believe these responsibilities should be explicit. A plan that says “follow up with someone” is less useful than one that identifies the clinician, the purpose of the appointment, and what happens if an appointment is delayed.

What is the plan for difficult days and transitions?

A care-planning conversation should leave room for the day when pain feels harder to manage. We would want that conversation to address whom you can contact, how concerns will be assessed, and what support is available if you feel overwhelmed or worried about returning to opioid use.

Consider asking: “What should happen if my pain worsens outside office hours?” and “How will we revisit the plan if I am not functioning better?” These questions concern the care process rather than access to a particular medication or therapy.

Continuity deserves attention, too. Within our substance use treatment program, individualized planning and aftercare are part of our approach. For someone living with pain, we believe transition discussions should include follow-up responsibilities, unresolved concerns, practical barriers, and a clear understanding of the next steps.

You deserve to know who will listen after the immediate treatment setting changes.

You deserve care that takes both conditions seriously

You do not need to minimize your pain to demonstrate commitment to recovery. You also do not need to arrive with a complete treatment plan. We believe a responsible starting point is a respectful assessment, shared goals, clear communication, and an honest explanation of what treatment can and cannot promise.

If you are considering support for opioid addiction and have concerns about pain, we invite you to reach out to us at Avalon Malibu at 888-958-7511. We welcome a conversation about your needs and questions.