Challenges in using opioids to treat pain in persons with substance use disorders

Addict Sci Clin Pract. 2008 Jun;4(2):4-25. doi: 10.1151/ascp08424.


Pain and substance abuse co-occur frequently, and each can make the other more difficult to treat. A knowledge of pain and its interrelationships with addiction enhances the addiction specialist's efficacy with many patients, both in the substance abuse setting and in collaboration with pain specialists. This article discusses the neurobiology and clinical presentation of pain and its synergies with substance use disorders, presents methodical approaches to the evaluation and treatment of pain that co-occurs with substance use disorders, and provides practical guidelines for the use of opioids to treat pain in individuals with histories of addiction. The authors consider that every pain complaint deserves careful investigation and every patient in pain has a right to effective treatment.

MeSH terms

  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Comorbidity
  • Cooperative Behavior
  • Diagnostic and Statistical Manual of Mental Disorders
  • Drug Tolerance
  • Humans
  • Long-Term Care
  • Motivation
  • Opioid-Related Disorders / diagnosis
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / etiology*
  • Opioid-Related Disorders / rehabilitation
  • Pain / drug therapy*
  • Pain / epidemiology
  • Patient Care Team
  • Primary Health Care
  • Secondary Prevention
  • Substance Withdrawal Syndrome / diagnosis
  • Substance Withdrawal Syndrome / etiology
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / rehabilitation*


  • Analgesics, Opioid