Addiction Treatment When You Have Chronic Pain

If you're living with chronic pain and opioid use disorder, you've likely heard the same frustrating advice over and over: "Just stop taking opioids." But when pain has been part of your daily life for months or years, that suggestion feels impossible—and dismissive of what you're actually going through.

Here's what's often missing from those conversations: both your pain and your opioid use disorder are real medical conditions. Both deserve treatment. And increasingly, we're learning that treating them together, rather than forcing you to choose between pain relief and recovery, leads to better outcomes for both.

This post will walk through how medication for addiction treatment (MAT) can work alongside chronic pain management, what multimodal pain strategies look like in practice, and how to build a care team that takes both conditions seriously.

Why Chronic Pain and Opioid Use Disorder Often Overlap

Chronic pain—defined as pain lasting more than three months—affects an estimated 50 million American adults. Many people with chronic pain were initially prescribed opioids for legitimate medical reasons: back injuries, fibromyalgia, arthritis, nerve damage, or post-surgical pain that never fully resolved.

What started as short-term pain relief sometimes becomes long-term dependence. Your body adapts to the medication. You need higher doses to manage the same level of pain. And at some point, you realize you can't function without it—not just because of pain, but because withdrawal feels unbearable.

This isn't a moral failure. Opioids change brain chemistry. They're effective pain relievers and highly addictive substances, and those two facts can exist simultaneously.

The challenge: many pain clinics won't prescribe opioids to patients in addiction treatment, and some addiction programs won't accept patients who are still taking pain medications. You end up caught between two systems that aren't designed to talk to each other.

Can Buprenorphine Help with Pain?

Buprenorphine—the active medication in Suboxone treatment—is primarily used to treat opioid use disorder, but it does have pain-relieving (analgesic) properties. Some patients report that their chronic pain improves on buprenorphine, especially at higher doses.

Here's how it works:

• Partial agonist activity: Buprenorphine binds to the same opioid receptors as full agonists (like oxycodone or morphine) but activates them less strongly. This provides some pain relief without the same level of euphoria or respiratory depression risk.
• Long duration: Because buprenorphine stays in your system for 24+ hours, it provides steady background pain control, avoiding the peaks and valleys of shorter-acting opioids.
• Ceiling effect: Buprenorphine's ceiling effect means increasing the dose beyond a certain point doesn't significantly increase pain relief—but it does reduce overdose risk compared to full agonist opioids.

For mild to moderate chronic pain, buprenorphine alone may be enough. For more severe pain, you'll likely need additional strategies.

Important: Buprenorphine for pain management is prescribed differently than buprenorphine for opioid use disorder. Your addiction treatment provider and pain specialist should coordinate dosing and monitoring.

Multimodal Pain Management: Beyond Medication

If you've been managing pain with opioids for years, the idea of reducing or stopping them can feel terrifying. Will the pain come roaring back? Will you be able to work, sleep, or take care of your family?

These are valid fears. But modern pain management increasingly focuses on multimodal approaches—combining several non-opioid treatments that work together to reduce pain and improve function. No single intervention replaces opioids entirely, but together, they often provide equal or better pain relief with fewer risks.

Physical Therapy and Movement

Chronic pain often leads to guarding and reduced movement, which can make pain worse over time. Physical therapy focuses on:

• Gentle strengthening to support injured or painful areas
• Stretching and mobility work to reduce stiffness
• Posture and body mechanics to prevent re-injury
• Gradual return to activity, which can reduce pain sensitivity over time

Even if movement hurts initially, working with a physical therapist trained in chronic pain can help you rebuild tolerance safely. Exercise in recovery also supports mental health and sleep quality.

Interventional Pain Procedures

For some types of chronic pain, targeted procedures can provide significant relief:

• Nerve blocks: Local anesthetic or steroid injections near specific nerves
• Epidural steroid injections: For spine-related pain
• Radiofrequency ablation: Uses heat to disrupt pain signals from specific nerves
• Spinal cord stimulation: Implanted device that sends electrical pulses to mask pain signals

These aren't first-line treatments, but for patients who haven't responded to conservative approaches, they can reduce pain enough to lower or eliminate opioid use.

Non-Opioid Medications

Several medication classes can help manage chronic pain without opioid-related risks:

• NSAIDs (ibuprofen, naproxen): Anti-inflammatory pain relief; not safe for everyone long-term
• Acetaminophen: Mild pain relief; safe in appropriate doses
• Gabapentin or pregabalin: For nerve pain (neuropathic pain)
• SNRIs (duloxetine, venlafaxine): Antidepressants that also treat chronic pain, especially fibromyalgia
• Topical treatments: Lidocaine patches, capsaicin cream, or compounded topical analgesics

Your pain specialist can help identify which medications are compatible with buprenorphine and your overall recovery plan.

Mind-Body Approaches

Chronic pain isn't "all in your head," but pain perception does involve the brain's interpretation of signals from the body. Therapies that address this connection can be surprisingly effective:

• Cognitive-behavioral therapy (CBT) for pain: Helps you change thought patterns that amplify pain
• Acceptance and commitment therapy (ACT): Focuses on living well with pain rather than eliminating it entirely
• Mindfulness meditation: Reduces pain catastrophizing and improves pain tolerance (learn more)
• Biofeedback: Teaches you to control physiological responses to pain
• Acupuncture: Some patients report significant pain relief, though research is mixed

These approaches work best alongside other treatments, not as replacements for medical care.

If you're ready to explore treatment that addresses both pain and recovery, Grata Health offers coordinated telehealth care in Virginia, Ohio, and Pennsylvania. Get started today.

Building a Coordinated Care Team

The key to managing chronic pain during addiction treatment is coordination. You need providers who communicate with each other and respect both conditions.

Your Addiction Treatment Provider

Your MAT provider (like Grata Health) prescribes and monitors your buprenorphine treatment. They should:

• Understand your pain history and current pain levels
• Adjust buprenorphine dosing to optimize both pain relief and opioid use disorder treatment
• Coordinate with your pain specialist on medication interactions
• Provide or refer you to counseling that addresses both pain and substance use

Your Pain Specialist

A pain management doctor focuses on non-opioid pain treatment strategies. They should:

• Review your complete medical history, including substance use
• Perform a thorough pain assessment to identify the source and type of pain
• Recommend multimodal treatments tailored to your specific pain condition
• Avoid prescribing full agonist opioids while you're on buprenorphine
• Communicate treatment plans with your MAT provider

In some cases, your primary care doctor or a physiatrist (physical medicine and rehabilitation specialist) can serve as your pain management provider.

Additional Team Members

Depending on your needs, your care team might also include:

• Physical therapist: For movement-based pain relief
• Mental health counselor: To address anxiety, depression, or trauma related to pain or substance use
• Pharmacist: To review all your medications for safety and interactions
• Case manager or peer support specialist: To help navigate insurance, appointments, and resources

Addressing the Fear of Undertreated Pain

One of the biggest barriers to starting addiction treatment when you have chronic pain is fear: What if my pain becomes unbearable? What if no one takes it seriously?

These fears are grounded in real experiences. Many people with chronic pain have been dismissed by healthcare providers, told the pain is exaggerated, or accused of drug-seeking when simply trying to function.

Here's what's important to know:

Your pain is real. Chronic pain has biological, neurological, and sometimes structural causes. It's not a character flaw or a ploy to get medications.

Buprenorphine won't necessarily make pain worse. Some patients worry that switching from full agonist opioids to buprenorphine will cause a pain spike. For most people, buprenorphine provides comparable pain relief, especially when combined with other pain management strategies.

You have the right to advocate for yourself. If a provider dismisses your pain or insists on stopping all pain treatment before addressing opioid use disorder, you can seek a second opinion. Look for providers experienced in treating both conditions (Grata Health specializes in this).

Recovery doesn't mean suffering. Effective addiction treatment improves quality of life—it shouldn't require you to live in agony.

What Treatment Looks Like When You Have Both Conditions

Let's walk through what a realistic treatment plan might look like for someone managing chronic pain and opioid use disorder.

Initial Assessment

Your first appointments will include:

• Medical history review: Previous pain treatments, current medications, substance use history
• Pain assessment: Location, intensity, triggers, impact on daily life
• Physical exam: To identify sources of pain and rule out new injuries or conditions
• Mental health screening: Depression and anxiety often accompany chronic pain and substance use

Induction Phase

If you're transitioning from full agonist opioids to buprenorphine:

• Your provider will time the switch carefully to avoid precipitated withdrawal
• You may experience some initial discomfort as your body adjusts
• Pain levels should stabilize within a few days to weeks
• Dosing may be adjusted based on both withdrawal symptoms and pain control

During this phase, you might also start non-opioid pain medications or therapies to support the transition.

Stabilization and Maintenance

Once you're stable on buprenorphine:

• Regular check-ins with your MAT provider (weekly or biweekly initially, then monthly)
• Physical therapy or other movement-based treatments
• Trial of non-opioid medications if needed
• Counseling to address triggers, stress, and pain-related anxiety
• Possible interventional pain procedures if conservative treatments aren't enough

Your care team will adjust treatments based on what's working. Pain management is iterative—it often takes time to find the right combination.

Long-Term Management

Over months and years:

• Some patients reduce or stop buprenorphine if pain and substance use are well-controlled; others continue long-term
• Pain management strategies evolve as your body and life circumstances change
• Regular reassessments ensure treatments remain effective and safe
• Focus shifts from crisis management to sustainable quality of life

Real Concerns About Dual Treatment

"Won't I just be trading one addiction for another?"

Buprenorphine is a medication, not a substitute addiction. It's prescribed to restore brain function disrupted by opioid use disorder—similar to how insulin treats diabetes. If you're taking it as prescribed and it's improving your life, you're not "addicted" in the harmful sense. You're treating a medical condition.

"What if my pain gets worse and I can't take anything stronger?"

This is a common fear. The truth is, most chronic pain doesn't respond well to long-term high-dose opioids anyway—tolerance builds, effectiveness decreases, and side effects accumulate. Multimodal pain management often provides better long-term outcomes. If you have a pain crisis or acute injury, buprenorphine can be adjusted or temporarily stopped under medical supervision to allow other pain treatments.

"Will people think I'm not really trying to get better?"

Unfortunately, stigma around both chronic pain and addiction is real. Some people may judge you for staying on buprenorphine or for needing pain management. What matters is that you know you're doing the work to improve your health. Find providers and support systems that respect both your pain and your recovery.

"Can I access this kind of care through telehealth?"

Yes. Grata Health provides coordinated telehealth treatment for opioid use disorder and chronic pain in Virginia, Ohio, and Pennsylvania. We work with most insurance plans, including Medicaid, and can connect you with physical therapists, counselors, and pain specialists as needed.

Practical Tips for Managing Both Conditions

Track your pain and function, not just pain levels. Instead of focusing solely on a 0-10 pain scale, note what you can do each day. Did you sleep better? Walk further? Spend time with family without constant distraction? Function is a better measure of treatment success than zero pain.

Set realistic goals. Complete pain elimination may not be possible, but reducing pain from an 8 to a 5—or from "debilitating" to "manageable"—can dramatically improve quality of life.

Build a daily routine. Consistency with medications, physical therapy exercises, sleep schedules, and stress management supports both pain and recovery.

Communicate openly with your providers. If pain worsens or you're tempted to use opioids outside your treatment plan, tell your care team. Adjustments can often be made before things escalate.

Lean on peer support. Connecting with others who manage chronic pain in recovery can reduce isolation and provide practical coping strategies. Ask your provider about support groups or recovery communities.

Moving Forward: Both Conditions Deserve Treatment

Living with chronic pain and opioid use disorder is hard. It requires navigating two complex medical systems, managing stigma from people who don't understand either condition, and making daily choices about your health without guarantees.

But here's what we know: both conditions are treatable. Buprenorphine can support recovery while providing pain relief. Multimodal pain management offers real alternatives to long-term high-dose opioids. And coordinated care from providers who take both conditions seriously makes all the difference.

You don't have to choose between managing pain and pursuing recovery. You deserve treatment that addresses your whole health.

Grata Health offers telehealth medication-assisted treatment with coordinated pain management support. We accept most insurance, including Medicaid, and provide same-day appointments in Virginia, Ohio, and Pennsylvania. Start your journey today.