Management of patients with comorbid substance abuse can be a challenge for providers. Providers may be hesitant to use narcotics in patients with history of substance abuse or currently receiving substance abuse treatment. However, these patients still may experience pain and should have their pain adequately treated.

Essential Questions and References

How does one treat pain in the setting of recovery from substance misuse?

  1. Substance Abuse and Mental Health Services Administration. Managing chronic pain in adults with or in recovery from substance use disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011. [Weblink]
  2. Miotto K, Kaufman A, Kong A, Jun G, Schwartz J. Managing co-occurring substance use and pain disorders. Psychiatric Clin North Am. 2012;35(2):393-409. DOI: 10.1016/j.psc.2012.03.006. PubMed PMID: 22640762.
  3. Chang Y-P, Compton P. Management of chronic pain with chronic opioid therapy in patients with substance use disorders. Addict Sci Clin Pract. 2013;8:21. DOI: 10.1186/1940-0640-8-21. PubMed PMID: 24341916; PubMed Central PMCID: PMC3904483.
  4. Cheatle M, Comer D, Wunsch M, Skoufalos A, Reddy Y. Treating pain in addicted patients: recommendations from an expert panel. Popul Health Manag. 2014;17(2):79-89. DOI: 10.1089/pop.2013.0041. PubMed PMID: 24138341; PubMed Central PMCID: PMC3996998.
  5. Liebschutz J, Beers D, Lange A. Managing Chronic Pain in Patients with Opioid Dependence. Curr Treat Options Psychiatry. 2014;1(2):204-223. DOI: 10.1007/s40501-014-0015-4. PubMed PMID: 24892008; PubMed Central PMCID: PMC4039557.
  6. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR Recomm Rep 2016;65:1-49. [PubMed]

What are the consequences of suboptimal pain control in the presence of substance misuse?

  1. Bounes V, Palmaro A, Lepeyre-Mestre M, Roussin A. Long-term consequences of acute pain for patients under methadone or buprenorphine maintenance treatment.  Pain Physician 2013;16(6):E739-47. [PubMed]
  2. Kampman K, Jarvis M. American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. J Addict Med. 2015;9(5):358-67. DOI: 10.1097/ADM.0000000000000166. PubMed PMID: 26406300; PubMed Central PMCID: PMC4605275.