Mental health

Chronic pain and addiction: When treatment becomes the problem

Published March 1, 2025 · 8 min read · Updated April 2026

Reviewed for accuracy by licensed clinical professionals.

How it develops

Opioids prescribed for legitimate chronic pain produce tolerance and physical dependence. Dose escalation follows. The medication shifts from treating pain to preventing withdrawal. Quality of life deteriorates despite increasing opioid doses.

The paradox

Chronic opioid use actually increases pain sensitivity (opioid-induced hyperalgesia). Patients may experience more pain on opioids than they would without them, but stopping causes withdrawal that includes pain amplification.

Treatment

MAT (buprenorphine treats both addiction and chronic pain). Multimodal pain management: physical therapy, nerve blocks, non-opioid medications (gabapentin, duloxetine, NSAIDs), cognitive-behavioral therapy for pain, mindfulness-based stress reduction. Gradual opioid taper with alternative pain management.

The key message

You do not have to choose between pain management and addiction recovery. Modern treatment addresses both. Many patients report better pain control after transitioning from opioid-only treatment to multimodal approaches.

Authoritative sources

This article references guidelines from: SAMHSA · NIDA · ASAM

Frequently asked questions

Should I treat both conditions at once?

Yes. Integrated treatment addressing both simultaneously produces significantly better outcomes than treating either alone.

How do I find a dual diagnosis program?

Search our directory or call SAMHSA at 1-800-662-4357 and specify you need dual diagnosis treatment.

Does insurance cover dual diagnosis treatment?

Yes. Under mental health parity laws, insurance covers both substance use and mental health treatment.

Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.