Chronic pain and opioid use disorder frequently occur together. According to the National Institute on Drug Abuse (NIDA), people with opioid use disorder often first received prescription opioids for legitimate pain conditions. This overlap creates a real clinical challenge: how do you manage genuine pain when opioids are no longer a safe option? The answer is that several effective, evidence-based alternatives exist — and many people in recovery use them successfully.
This article is for informational purposes only and does not constitute medical advice. Always work with a qualified healthcare provider when making decisions about pain management in recovery.
Untreated or undertreated pain is one of the most common drivers of relapse. When someone in recovery faces significant pain — from an injury, chronic condition, or surgery — the fear that there is no way to cope without opioids can feel overwhelming. Understanding your full range of options gives recovery a stronger foundation.
The 2022 CDC Clinical Practice Guideline for Prescribing Opioids emphasizes that non-opioid therapies are frequently as effective as opioids for many types of chronic pain, and often carry fewer long-term risks. Options include:
Disclosure is essential. If you are in recovery and face a pain management situation, tell every provider involved — your primary care physician, specialist, dentist, and surgeon. SAMHSA's National Helpline (1-800-662-4357, free and confidential, 24/7) can connect you with professionals experienced in treating co-occurring pain and addiction. Integrated care — where your addiction medicine provider and pain specialist communicate directly — consistently produces better outcomes than fragmented care.
Many people in recovery worry about situations where opioids might be prescribed, such as after a dental procedure, injury, or surgery. MedlinePlus, a resource of the National Library of Medicine, notes that non-opioid alternatives are frequently sufficient for post-procedural pain when used promptly and appropriately. If opioids are medically necessary, a short-duration prescription with a clear taper plan — coordinated with your addiction medicine team — reduces risk substantially. When possible, discuss pain management before a scheduled procedure so a written plan is in place in advance.
If you are on medication-assisted treatment (MAT) with buprenorphine or methadone, your maintenance medication provides some baseline analgesic effect. Stopping MAT before a painful procedure to "avoid opioids" is never recommended — it raises relapse risk without improving pain control. Your MAT provider can adjust your treatment protocol for planned procedures. Naltrexone requires special planning if surgery is anticipated, since it blocks opioid receptors; your provider will guide you through this safely.
Chronic pain frequently co-occurs with depression, anxiety, and trauma — conditions that also drive substance use. Treating pain without addressing these underlying conditions often produces incomplete results. If you suspect a co-occurring mental health condition is worsening your pain or your recovery, ask about dual diagnosis treatment that addresses addiction and mental health together.
At California Treatment Centers, our clinical team has experience supporting people who manage chronic pain alongside addiction. We work with most major insurers and have multiple locations across California. If you or a loved one is navigating pain and substance use, call us at 213-321-6518. For free, confidential support any time, reach the SAMHSA National Helpline at 1-800-662-4357 or call or text 988 to reach the Suicide and Crisis Lifeline.
Recovery is possible even when pain is part of the picture. Evidence-based, non-opioid strategies — used within a comprehensive treatment plan — give people a real path to healing without returning to opioids.
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