Chronic Pain and Opioid Use: Planning Pain Care in Rehab

Someone who has lived with chronic pain and developed opioid use disorder is often told two things at once: you cannot go back to the same prescriptions, and the pain is not going anywhere. Both statements can be true, and neither one means residential treatment is the wrong door. This article explains how pain care is usually planned alongside substance use treatment, what to ask before admission, and what you can do this week to make the conversation easier. It is educational and does not replace advice from your own prescriber.

What chronic pain means in a substance use treatment setting

The CDC’s 2022 Clinical Practice Guideline for Prescribing Opioids for Pain, which contains 12 recommendations, defines chronic pain as pain lasting more than three months. That definition matters because it separates the pain that follows an injury or surgery from the pain that has become a long-term condition with its own management plan. Annandale Behavioral Health is a licensed substance use disorder residence in the Los Angeles and Pasadena area, and we treat pain as a co-occurring condition for people who are also being treated for opioid or other substance use. Chronic pain on its own is not the reason for admission; the substance use disorder is.

In practice this means two clinical questions run side by side. One is how to stabilise opioid use safely. The other is how to keep a person’s pain from becoming the reason they leave treatment early, which is one of the most common fears people raise on a first phone call. You can read the CDC’s overview of the guideline for the national framework that prescribers use.

A liftable summary: how pain is handled during residential treatment

When a person with chronic pain and opioid use disorder enters residential substance use treatment, the care team typically reviews every current pain medication, confirms who prescribes it, builds a written plan that pairs medically supervised withdrawal or stabilisation with non-opioid pain strategies, and schedules a pain-focused follow-up before discharge. The CDC’s 2022 guideline contains 12 recommendations and describes chronic pain as lasting more than three months; its stated intent is not to push rapid tapering or abrupt discontinuation of opioids for patients who are already taking them. Because withdrawal and pain can overlap, the plan should be agreed in writing with the prescriber before any dose changes.

Why pain and opioid use disorder complicate each other

Pain as a relapse trigger: Untreated or poorly explained pain is a common reason people return to opioids after discharge, so a plan that ignores pain is a plan that is likely to fail.

Withdrawal that mimics pain: Muscle aches, joint pain and restlessness are part of opioid withdrawal, which can make an old pain condition feel suddenly worse even when the underlying problem has not changed.

Sleep disruption: Poor sleep lowers pain tolerance and increases cravings, and sleep is often the first thing to unravel during early recovery.

Fear of undertreatment: Many people avoid asking for help with pain because they expect to be treated as drug-seeking, which delays an honest conversation about what they actually take.

Multiple prescribers: A pain specialist, a primary care doctor and an urgent care clinic may each hold part of the medication history, and no one of them sees the whole picture.

What a pain plan can include

A written plan usually combines several parts rather than relying on any single approach. The details depend on your medical history and what your doctors recommend, so treat the following as a list of topics to raise, not a prescription.

Non-opioid medication options are discussed with a physician, including which ones are appropriate for someone with a substance use history. Physical approaches such as gentle movement, heat and stretching can be built into a daily schedule. Behavioural approaches, including cognitive behavioural therapy, help people change how they respond to pain flare-ups. For people whose opioid use disorder calls for medication, methadone dosing through an opioid treatment program and buprenorphine both have a role, and a physician decides what fits. NIDA’s overview of opioids explains how these medications work at a general level.

Any plan that involves reducing or stopping a long-term opioid, a benzodiazepine or alcohol should happen under medical supervision. Alcohol and benzodiazepine withdrawal carry a risk of seizures, and opioid withdrawal can be dangerous for people with other medical conditions, so supervision is required rather than optional. Our page on medical detox in Los Angeles describes how that supervision works.

Questions to ask before you are admitted

Because this is a logistics question as much as a clinical one, the most useful preparation is a short list of things to confirm in advance. Ask each program these directly, and expect plain answers.

Prescriber contact: Will the team speak with the doctor who currently prescribes your pain medication, and with your permission, how is that documented?

Medication continuity: Which of your current prescriptions will continue, which will be adjusted, and who makes that decision?

Flare-up response: What happens at two in the morning if your pain spikes, and who is on site? At a small six-bed residence this is a fair thing to ask, because staffing differs from one program to the next.

Off-site appointments: Can you keep an existing physical therapy or pain specialist appointment, and how is transport arranged? Our article on what to bring regarding medications at admission covers the paperwork side of this.

Discharge pain plan: Who will manage your pain after you leave, and is there a named appointment before your discharge date?

One thing to do today

Write down every medication you take for pain, including doses, how often, the prescriber’s name and the pharmacy. Add anything over the counter and any alcohol you use to sleep or to manage pain. Bring that list to your next appointment and ask your prescriber one question: “If I get help for opioid use, who will manage my pain plan while I do?” Having that sentence ready usually shortens a hard conversation. You can also call us at (855) 778-8668 to talk through what a plan might look like, or call the free, confidential SAMHSA National Helpline at 1-800-662-HELP (4357), which operates 24 hours a day, 365 days a year in English and Spanish. The SAMHSA helpline page explains what the call involves.

How co-occurring conditions fit into care

Chronic pain often sits alongside depression, anxiety, trauma-related symptoms and insomnia. When these are present together with a substance use disorder, treatment addresses them as co-occurring conditions within the same plan. Our page on dual diagnosis treatment in Los Angeles explains this approach. It is worth saying plainly that the substance use disorder is what brings a person into our residence; the other conditions are treated alongside it, and your doctors remain part of that team.

What to expect and what we cannot promise

No residence can promise that pain will disappear, and anyone who does should be questioned. The realistic goal is a plan you understand, a medication list that is accurate, and a team that takes your pain seriously while treating the opioid use disorder. Recovery from substance use disorders is possible, but timelines and outcomes differ for each person, and some people need more than one episode of care. If you are in a medical emergency, call 911. If you are thinking about harming yourself, call or text 988, the Suicide and Crisis Lifeline, at any hour.

When you are ready to talk about what residential care could look like, our admissions team is at (855) 778-8668. You can also read about residential treatment in Los Angeles before you call.

This article is for educational purposes only and is not medical advice, a diagnosis or a treatment recommendation. Do not change or stop any prescribed medication without speaking to your prescriber. Withdrawal from alcohol, benzodiazepines and opioids can be dangerous and should be supervised by medical professionals.