CHRONIC PAIN & ADDICTION

Where Chronic Pain and Addiction Meet

My background is in pain medicine. I came to addiction medicine through it, after recognizing — over years of practice — that a significant number of chronic pain patients were also struggling with addiction, mental illness, or both, and that the standard clinical response to this was to discharge them. That approach never made sense to me. Medicine tends to organize itself around single conditions. When two are present and intertwined, the system has no obvious place for the patient.

Chronic pain and addiction are frequently intertwined, and understanding the relationship between them is essential to treating either one effectively. Pain drives substance use; substance use complicates pain; withdrawal amplifies pain; and the toll of living with chronic pain — the anxiety, the depression, the disruption to identity and function — often underlies both.

The Neuroscience of Chronic Pain

Chronic pain is not simply a persistent version of acute pain. The transition from acute to chronic involves fundamental changes in how the nervous system processes pain signals — changes that require treatment of both the physical and psychological dimensions simultaneously. Over time, the nervous system begins to amplify rather than simply transmit pain: stimuli that would normally produce no pain become painful, and mild pain becomes severe. The brain itself undergoes structural and functional reorganization that affects both the sensory and emotional dimensions of pain.

Psychological state also shapes pain perception directly, through neural systems that regulate the gain on incoming pain signals. Anxiety, depression, fear, and prior experience all influence how pain is processed at a neurological level. Stress magnifies pain. This is not a psychological explanation for physical pain; it is the neuroscience of how pain actually works. Treating chronic pain as a purely mechanical problem, solvable with the right medication or procedure, misses much of what is happening.

How I Approach It

I treat chronic pain and addiction as co-occurring conditions — not as two separate problems requiring separate specialists. This means addressing the medical management of pain, the dependence on any pain medications, and the psychological factors sustaining both. The pain often becomes entangled with other experiences in ways that neither the patient nor their previous physicians have fully understood.

This kind of integrated treatment is rare. People with both conditions often find themselves without adequate care for either — addiction specialists who won’t engage with pain, pain physicians who won’t engage with addiction, and no one holding both. This practice is built for that situation.

For patients who have developed dependence on opioids or other pain medications, the approach to tapering is gradual and medically supervised, set by the individual’s clinical stability. The goal is not simply to remove medication but to arrive at a state where pain is managed more effectively, and with less collateral cost, than before.

Frequently Asked Questions

Q: I’ve been on pain medication for a long time and things have gotten complicated. Is that something you work with?

A: Yes. Pain treatment that begins straightforwardly can become complicated over time — the medication may feel less effective, harder to control, or difficult to imagine stopping even when it isn’t clearly helping. That kind of situation, where pain and dependence have merged, is exactly what this practice is designed to address.

Q: My previous doctors told me my pain was psychological. Is that what you think?

A: No — and the opposite error is equally unhelpful. Dismissing pain as psychological denies the reality of the patient’s suffering. Pain that is treated as though it had nothing to do with emotional life will not improve as much as it could. Pain may be entirely real and still carry meanings and functions that physical evaluation cannot capture. The goal is to take the pain seriously as pain while remaining curious about everything it has come to carry.

Q: Does this mean you’re going to take away my pain medication?

A: No. The goal is better pain treatment, not medication removal. Part of that means identifying what is actually driving the pain and what is most likely to help it — which isn’t always what has been tried so far. Not all types of pain respond to the same treatments, and if something more effective exists for a particular condition, with less impact on the rest of a person’s life, that is worth finding.

Q: I’ve been dealing with this for years and I’m exhausted. Is there anything that can actually help?

A: Chronic pain that has been present for years — especially alongside dependence on medication — takes a serious toll. The distress it produces can become as difficult to bear as the pain itself, and the two become hard to separate. Treatment has to account for both: the pain itself and everything that has accumulated around it. That work is slow, and it doesn’t follow a fixed course. But it is possible to arrive at a place where both are more manageable than they are now.

Getting in Touch

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