YOU CAN MANAGE YOUR 

CHRONIC PAIN

TO LIVE A GOOD LIFE 

A GUIDE FOR PEOPLE 

IN RECOVERY FROM 

MENTAL ILLNESS 

OR ADDICTION 
Contents
 

Chronic pain doesn’t mean you
 

always have to suffer................................................1
 

You can work with healthcare providers to
 

manage your pain....................................................1
 

Your pain can be treated in many ways...............11
 

Medications can provide you with some relief......17
 

Pain management begins with you........................23
 

Resources.................................................................24
 
Chronic pain doesn’t mean you always have 

to suffer. 

The word chronic means constant, lasting a long time, or coming 

back again and again. When you have pain that has bothered you 

for more than 3 months and doesn’t seem to get better with time, 

you may be experiencing chronic pain. 

Major causes of chronic pain include lower back problems, nerve 

damage, and migraine headaches. Pain also can be a part of many 

diseases, such as sickle cell anemia, arthritis, pancreatitis, fibromyalgia, 

and HIV/AIDS. There are many other causes of pain, and sometimes 

the cause is unknown. 

Chronic pain can be difficult to bear, even awful. It can lead you to 

lose sleep, to become anxious and depressed, to have a hard time 

keeping up on the job, and to stop doing things you did before. These 

changes can add stress, produce more pain, and trigger new health 

problems. If unmanaged, pain can become the center of your life. 

In many cases, chronic pain is a lifelong condition. However, by 

managing your pain, you can usually continue to enjoy the activities 

that matter to you. One of the most important things you can do to 

manage your pain is to safeguard your recovery from mental illness 

or addiction. A clear mind helps you think better, so that you take 

the right steps to manage your pain. 

You can work with healthcare providers to 

manage your pain. 

If you have chronic pain, talk to your healthcare providers about 

it at your next scheduled appointment, or set up a new appointment 

just for this purpose. Don’t put off talking to your care providers in 

hope that the pain will go away. Medical professionals may be able 

to determine what’s causing the pain and help you deal with that 

problem. Even if the source of pain remains a mystery, care providers 

can work with you to try different strategies until you find a 

combination that reduces your suffering. 

1 
Why? 

My recovery’s more 

important than ever. 

Because I need to be thinking 

straight, so I do what works 

to manage the pain.

2 
If you have a history with drugs or alcohol, you may hesitate to seek 

medical care for your pain. If you have a history of mental illness, you 

may be equally reluctant. You may be afraid that care providers will 

judge you or think you are being dishonest. Or, you may be afraid 

that you will be persuaded to take medications that could trigger your 

addiction. If you don’t know what’s causing the pain, you might be 

afraid that others will think it’s all in your head. 

But for your own sake, you should contact a care provider. Chances 

are good that the professionals you meet with will treat you respectfully, help you maintain your recovery, and work with you to find 

ways to reduce your pain. If this isn’t true for the first care providers 

you contact, then you may want to meet with others who are more 

responsive to your concerns. 

Many different types of care providers can work with you to manage 

pain. These include primary care doctors or specialists, nurses, and 

other members of a doctor’s team including physician assistants and 

nurse practitioners. Psychologists, addiction treatment counselors, 

and other types of counselors also may be able to help. 

Several professionals may become involved in your pain care. If this is 

the case, it’s important that they coordinate your care with each other. 

You can help make sure this happens by asking,“Who is serving as 

the point person for my pain care?” 

It can help to have care providers who are experienced in pain 

management for people who have histories of mental illness or 

addiction. If your care providers do not have that experience, you 

may want to have them consult with someone who does, such as your 

own counselor or some other mental health professional or addiction 

specialist. You also can direct them to resources on this topic (see 

page 24). 

3 
Help your care providers understand how much 

pain you have. 

When you meet with care providers about your pain, they will try 

to learn where the pain is coming from and what it is like. They will 

ask questions about your general health and your exercise habits. 

They also will ask specific questions about the pain. 

Pain usually increases and decreases across time, so it is important 

for your care providers to know the most pain, the least pain, and 

the typical pain you feel in a given day. Since pain treatment often 

does not make all pain go away, care providers also will need to 

know what level of pain you can live with. This can be different 

from person to person. 

You may be asked to rate episodes of pain on a numerical scale of 

0 to 10, or on a picture scale, such as a set of frowning and smiling 

faces. You also may be asked to use a scale to rate your quality of life 

on such factors as sleep, stress, and ability to perform daily activities. 

Having high scores doesn’t mean your pain is impossible to treat, 

and having low scores doesn’t mean you should try to ignore your 

pain. Pain scores are just one of many tools that care providers use 

to understand your pain. Every time you see your care providers about 

pain, you may be asked to give pain scores. These will be compared 

with your past pain scores to see if treatment is helping to reduce 

your pain. 

QUESTIONS TO EXPECT—INFORMATION TO SHARE 

• When and how did your pain start? 

• What does your pain feel like (shooting, stinging, aching)? 

• How well are you able to manage your pain on a typical day, 

on a scale of 0 to 10? 

• What makes you feel better or worse? 

• What have you tried in the past to ease your pain? 

• What other medical conditions do you have? 

4 
Be as specific as you can about your level of pain. 

Sometimes your pain can feel like an 11 on a scale of 0 to 10. 

Chronic pain affects more than your body—it can affect your mood, 

your relationships, and your ability to be independent. It can also 

challenge your recovery from mental illness or addiction. When you 

are asked to rate your pain level, try to separate the feeling of pain 

from the suffering and disruption it is causing. Name a level that is only 

about your pain. 

Try not to underreport or overreport your pain. 

If you are worried that your care providers will prescribe medications 

that could put your recovery at risk, you may be tempted to report 

less pain than you feel. On the other hand, if you are worried that 

your care providers won’t give you pain relief medications unless 

your pain is unbearable, you may be tempted to report more pain 

than you feel. 

In general, your pain level is only one factor that is considered when 

prescribing pain medications. Be straightforward about your pain 

level, and speak up about your concerns about pain medications. 

Help your care providers understand how the pain 

affects you. 

Try not to answer questions about pain with one word, such as “yes,” 

“no,” or “fine.” Instead, give some details. Help your care providers 

understand what activities are important to you, but that are hard 

to do now because of your pain. 

QUESTIONS TO EXPECT—INFORMATION TO SHARE 

• How is your mood? 

• Does the pain affect your sleep, your sex life, or your appetite? 

• Has the pain affected your relationships with important people in 

your life? 

• Are you able to dress, shower, prepare food, and do other things 

you need to do to live independently?
 

• Are you able to work? 

• Are there things you have stopped doing because of your pain? 

• What have you given up, because of the pain, but would like to 

do again?
 

5 
What if that 

doesn’t work? 

I was worried that 

the doctor wouldn’t 

help me because I 

used to use drugs... 

...but he was cool. 

He’s having me 

start with physical 

therapy. 

He says we’ll work together 

to find the combination that 

eases my pain but doesn’t 

add new problems. 

Mine, too! 

Well, that eases 

my mind.

Be ready to share information about your mental 

and emotional health. 

Some conditions can make your chronic pain worse. For example, 

if you were in an accident or terrible incident, you may have flashbacks 

or other symptoms of posttraumatic stress disorder (PTSD). These 

can make pain more intense. Being depressed, anxious, or under a 

lot of stress can make pain feel worse, too.Your care providers will 

ask questions about your state of mind, because the way you feel 

mentally and emotionally has a bearing on the best way to treat 

your pain while minimizing risk to your recovery. 

QUESTIONS TO EXPECT—INFORMATION TO SHARE 

• Have you ever been diagnosed or treated for depression, anxiety, 

an eating disorder, or some other psychiatric condition? 

• Did the pain start after an accident? 

• Have you ever hurt your head or been diagnosed with traumatic 

brain injury? 

• Do you have a history of physical, sexual, or emotional abuse 

or trauma? 

6 
How are you 

sleeping these days? You asked me 

that last time. 

It may seem like I wasn’t 

listening last time, but I’m 

going to ask this question 

each time I see you. 

So I can tell if our plan 

to treat your pain is 

working over time. 

Why? 

Disclose to care providers your addiction and 

recovery history. 

It’s very important that your care providers know your history of 

drug and alcohol use and about your progress in recovery. If they 

don’t ask about this, you should volunteer the information, so that 

they can develop a pain management plan that fits with your 

recovery plan. Be sure to mention if you are in recovery with 

the help of medications, such as methadone, buprenorphine, or 

naltrexone. These medications can affect how pain medications 

work for you.Your doctor is required by law to keep this information 

confidential and not share it with others (such as employers) who 

are not involved in your health care. 

QUESTIONS TO EXPECT—INFORMATION TO SHARE 

• What substances (drugs or alcohol) have you used in the past? 

• What is your family history of drug use or drinking? 

• How old were you when you first started using drugs or drinking? 

• How recently did you stop using? 

• Have you been to treatment for drug or alcohol use? 

• How is your abstinence? 

• What over-the-counter or prescription medications are you taking? 

• Do you attend recovery group meetings? 

• Do you have a sponsor and abstinent friends? 

7 
Why are you asking about 

my mood? Do you think the 

pain is all in my head? 

Just the opposite. 

Being sad, depressed, or angry 

can make your pain worse. 

Okay. I need to know how you feel, 

so we can figure out what might 

work best to reduce the pain. 

Well, I’m pretty angry and 

frustrated, that’s for sure. 

Your care providers may want to speak to other 

people in your life. 

Your care providers may want to talk with other medical professionals 

who are treating you or have done so in the past. They also may want 

to talk with members of your household, your pharmacist, or your 

counselor. This can feel like an invasion of privacy or a sign that you 

aren’t trusted. However, this communication helps care providers 

have a better understanding of your pain. It gives them the information 

they need to know in order to treat your pain and how to get you the 

support you need as you try new ways to manage your pain. 

Your doctor is legally permitted to talk about your condition to other 

doctors or healthcare personnel who are actively involved in your 

care, without your specific permission. However, many doctors will 

want to be sure such communication is okay with you. Your doctor 

must obtain your permission before talking with friends or family or 

others who are not part of your care team. Your doctor also is legally 

permitted to review your prescription record in your state’s prescription 

drug monitoring program. 

8 
Make sure you understand your treatment. 

When you are in pain, it can be difficult to listen carefully and to 

understand everything you are told. It is okay to ask for information 

to be repeated, to ask for instructions in writing, or to bring a tape 

recorder and ask if you can record the discussion so that you can 

listen again when you get home. It may help to have a family member 

or friend come to appointments, to help you remember what you are 

being told about your condition, what you need to do, and how to do it. 

It also can be a good idea to write down your descriptions of pain 

and your questions, before arriving at an appointment, so that you 

remember what you want to say or ask. 

Your care providers may give you handouts or tell you about Web sites 

to visit to learn more about your treatment. If you don’t understand 

this material, ask for help. 

At all points in your care, you can and should ask questions to make 

sure you understand your treatment. You are your most important 

caretaker, so do not hesitate to speak up if you do not understand 

information about your treatment plan. 

QUESTIONS YOU CAN ASK 

• What is my diagnosis? 

• What treatments are available, especially treatments that don’t 

involve taking medications? 

• What are the risks and benefits of each treatment option? 

• What should I do if I have new pain, such as from a fall? 

• What should I do if I have an episode of intense pain (often called 

“acute pain”)?
 

• What should I do if I need surgery? 

• How will my treatment for pain affect my addiction recovery effort? 

• What should I do if I relapse? 

9 
 I’m sorry, I wasn’t clear. You 

will take one pill in the morning 

and one pill at night. 

Take this pill two times a day, 

in the morning and at bedtime. 

Let me make sure I heard what you 

said. I’m going to take two pills in the 

morning and two pills at bedtime. 

Before you go, let’s write 

up a schedule for when 

to take all your pills, 

including this new one. 

I think I’ve got it now. 

I’m going to take one 

pill when I get up and 

one pill before I go 

to sleep. 

Go to specialists if you are referred. 

No one medical professional can have expert knowledge about every 

aspect of your health. If your care providers need more information, 

they may refer you to other experts, such as pain specialists, addiction 

specialists, or psychiatrists. Referrals do not mean that your care 

providers think you have relapsed, that your pain is imaginary, or 

that you aren’t worth bothering about. Having a team of people to 

help you manage your pain can improve your chances of success. If 

you get a referral to see a specialist, make the appointment as soon 

as possible. 

Work with care providers to create a pain 

management plan. 

Chronic pain differs from person to person and from one moment 

to the next. That’s why you need to have a pain management plan 

that’s designed for you. This plan may include both action steps and 

medications for overall management of pain, plus guidance on what to 

do when you have episodes of acute pain. 

It’s important to note that pain management is a process. You and your 

care providers will need to monitor your plan on an ongoing basis and 

make adjustments as needed, so that it continues to help you manage 

your pain.

10 
Go back for checkups. 

Your care providers will want to see you again after you start a 

pain management plan. This is so they can find out how the plan is 

working for you and make adjustments as needed. These meetings 

are opportunities for you to ask any questions you might have. 

Checkups also can help you avoid addiction risk behaviors. Care 

providers can look for signs that show unusual drug use on your 

part, such as borrowing somebody else’s medications or increasing doses of the medication you take without prior approval. Your 

care providers will try to determine whether such behavior indicates 

your pain is not being treated effectively or whether you are having 

a relapse. In either case, your care providers will work with you to 

make sure your pain is managed in the best way possible while 

protecting your recovery. 

Your pain can be treated in many ways. 

Your care providers may advise you to do a number of things to 

reduce your pain. If you are already taking steps on your own to 

manage your chronic pain, tell your care providers. If they don’t 

ask about this, volunteer the information, so that it is part of the 

management plan you build together. 

Each piece of your plan may help to some degree. All of the pieces 

together may do quite a bit to ease the pain. Some of them will 

require a significant commitment and active involvement, but they 

can be the keys to effective management of pain. 

Get the benefits of exercise. 

Exercise can make you stronger and more flexible, speed recovery 

from injury, improve your balance, and brighten your mood. All 

of these things can reduce pain and improve your quality of life. 

Your care providers may recommend specific exercises as well as 

the amount of exercise to do. Follow these instructions, so that you 

obtain benefit from the exercise without putting yourself at risk for 

more pain and injury. 

11 
I don’t hurt as much 

since I started my 

exercises. 

Yes, I can tell that you’re not as 

stiff and have better balance. 

This makes it less likely that you 

will reinjure yourself. 

My pants are fitting 

better, too! 

That’s another bonus. 

Slimming down is reducing 

the strain on your body. 

Your care providers may refer you to a physical therapist who can 

teach you exercises, help you do them, and advise you on how hard 

to push yourself or when to go easy. The physical therapist also can 

teach you how to do daily activities in ways that limit the pain—for 

example, smart ways to get out of a chair, to lift your arms while 

dressing, or to carry groceries. 

Counseling can help. 

Your doctor may recommend you for a kind of counseling that has 

been quite helpful for many people in pain, as well as for people 

in recovery. This counseling, called cognitive–behavioral therapy, 

is usually offered in small group classes that last several weeks. In 

the classes, you learn how to manage your attitude toward pain to 

change how you experience it. 

12 
Whenever I feel the 

pain coming on, I put 

myself in a garden 

and count the roses. 

I distract myself 

by thinking about 

fast cars. 

All I can think about 

is how much I hurt. It doesn’t have 

to be that way. 

You can learn how to pace your activities to reduce pain, and to 

create a plan to manage sudden increases in pain. You also can learn 

techniques that help you relax or fall asleep. This, too, is important 

because you can often reduce the sensation of pain by being rested. 

Another important tool you will learn is how to distract yourself 

from thinking about the pain all the time. Your counselor will help 

you learn and practice these techniques until they become automatic. 

Consider alternative treatments as add-ons to 

your plan. 

There are many types of treatment for which there is not yet enough 

scientific evidence to say whether they really work to reduce pain. 

Some of these treatments can cause problems when combined with 

the management plan you and your care providers have put together. 

But others may possibly be helpful to you, or at least do no harm. 

Check with your care providers before starting any extra treatment, 

to make sure it fits with what you are already doing. 

13 
ALTERNATIVE TREATMENTS TO CONSIDER 

Herbs and vitamins—Nutritional supplements that may improve 

overall health and the body’s ability to resist pain signals 

Massage or vibration—The use of hands, rollers, or electronic 

devices to relieve muscles and reduce sensations of pain 

Acupuncture—The insertion of very fine needles into the skin at 

specific points, to improve the body’s control over pain sensations 

Chiropractic treatment—The manipulation of the spine, joints, and 

muscles, so that they move with less pain 

TENS (transcutaneous electrical nerve stimulation)—The use of 

an electronic device to stimulate nerves and block pain signals 

Cold therapy—The use of ice packs against the site of an acute 

injury, to reduce swelling and pain 

Heat therapy—The use of warmth, such as with a heating pad, to 

provide relief for sore or stiff muscles or for joint pain 

Braces and body supports—Products that relieve pressure on 

injured parts of the body, such as the knee or lower back, to reduce 

pain and restore function 

Meditation—A mental technique of emptying the mind of thoughts or 

focusing on one thought, to relax, become calm, and improve coping 

with pain 

I asked my doctor about 

those Chinese herbs you 

told me to take. 

One is okay, but the other might 

interfere with my medication. 

Then she said I should take up 

tai chi. You heard of that? 

Sure. Tai chi involves 

slow movements, almost 

like meditation. 

What did 

she say? 

It’s exercise I can handle, 

and it’s good for my balance. 

I can’t afford to fall again! 

14 
I hurt so bad this 

morning, I almost 

didn’t get out of bed. 

Me, too. I was ready 

to break into a liquor 

store on my way here. How do you 

feel now? 

Just talking to you guys 

makes me feel better. 

Sometimes I have to force myself 

to come to these meetings, but I 

never regret it once I’m here. 

Keep up your recovery from mental illness. 

Many people with chronic pain have anxiety, depression, or PTSD. 

These conditions can make pain feel worse. They also can make it 

difficult to stick to a pain management plan. If you are affected by 

these symptoms, your pain management plan may need to include 

extra mental health supports such as counseling, participation in a 

mutual-help group, or medications to treat the mental illness. 

Maintain your addiction recovery. 

Relapse prevention is very important to pain management, and 

vice versa. Fortunately, many of the things that help with pain— 

such as having a positive attitude, keeping busy, and learning coping 

skills—help control cravings and prevent relapse. Taking an active 

part in your pain management has a double reward, because it can 

strengthen your recovery from addiction while helping you 

manage your pain. 

15 
Set goals. 

One of the most important things you can do is reclaim your life 

from the pain. Think about the simple and enjoyable activities that 

you have given up because of pain, but would like to do again. For 

example, your goal might be gardening, taking a walk, spending 

time with your family without thinking about pain, or getting back 

to work. 

Also think about new things you would like to do, even though 

your life has been changed by pain. For example, perhaps you 

would like to learn to draw, to keep a journal, or to exercise in a new, 

pain-free way. 

Tell your care providers about your goals for an improved 

quality of life, and ask for help achieving them. Put these goals in 

your pain management plan, and work with your care providers to 

find ways to measure progress toward the goals. 

I used to love going to the 

movies—eating popcorn, watching 

the previews and the feature film. 

So, you’d like to be able to sit for 

about 2 hours without back pain? 

Would you be willing to do 

some different stretches 

and exercises to try to 

achieve that goal? 

Okay. Let’s see if we 

can get you ready 

to enjoy a night at 

the movies by your 

next birthday. 

Yes. 

Sure. 

16 
Medications can provide you with some relief. 

Medications for pain come in several forms, including pills, patches, 

and injections. But no medication is a magic cure for chronic pain. 

Managing your pain and improving your quality of life will almost 

never depend on medications alone. However, they can be an 

important part of your overall treatment plan. You will need to 

discuss with your care providers the risks that pain medications 

present to your recovery and how you will manage those risks. 

Lower-risk medications are your first choice. 

If you are in recovery from mental illness or addiction, your best 

first choice for pain medication will be a kind that does not 

have addictive properties. Several such kinds of medications are 

available. Each has been found to be most helpful for particular 

types of pain. Some types are prescribed, and other types can be 

purchased at a pharmacy over the counter. 

Your care providers might have you take acetaminophen 

medication, which is typically used to treat headaches and aches 

and pains. Topical creams and ointments may offer some relief 

for pain in one particular part of the body, such as on the knee or 

elbow. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be 

helpful for several types of pain, including bone pain or pain caused 

by swelling and inflammation. 

Other medications that were originally developed to serve other 

purposes have been found to have pain-relieving properties 

for certain conditions. These include medications for depression, 

anxiety, and seizures. 

Some medications for pain are not recommended for use with 

people in recovery. These include benzodiazepines (for anxiety) 

and cannabinoids (which are derived from marijuana). 

Any medication can have side effects, even when used exactly as 

prescribed. For these reasons, it is important to always take 

medications under the supervision of your care providers, to take 

them exactly as directed, and to report any side effects. 

17 
We’re not quite sure how it works, 

but we think antidepressants 

dampen pain signals. Within 

several weeks you could start to 

feel a real difference.

 I’d like to put you on an 

antidepressant. 

I’m not depressed, 

doc, I just hurt 

like the dickens. 

I don’t want to 

wait that long. 

I don’t want you to, either. So let’s 

talk about what else we can do in 

the meantime to relieve the pain. 

Medications with addictive potential may be 

appropriate in some cases. 

If your pain continues to persist at unmanageable levels, your 

care providers may work with you to try an opioid (“narcotic”) 

medication. Opioids are strong medications that provide relief 

for some types of pain. However, even when they work well, they 

have limitations, and they can lead to abuse and addiction. Opioid 

medications will be recommended to you only if the potential 

benefits outweigh the risks. They will be prescribed with carefully set 

limits and boundaries, and only for as long as they are clearly helping. 

A history of drug addiction or abuse does not necessarily rule out 

opioid medication for pain. However, before you go this route, you 

and your care providers should carefully consider your recovery status, 

support network, and other factors that can help you avoid relapse. 

Your care providers will consider your recovery status to determine 

the kind and form of opioid that will be safest for you to take. 

18 
If you are in medication-assisted treatment for opioid addiction, 

your pain treatment doctor will want to communicate with your 

addiction treatment provider. If you are on buprenorphine, it may 

be possible to adjust your dose schedule to provide some pain 

relief. If you are on methadone, you may be able to take an opioid 

medication for pain. Opioids will not be effective if you are taking 

naltrexone. Any adjustments in your medications will require 

careful coordination of care. 

TYPES OF OPIOID MEDICATIONS 

Buprenorphine 

Codeine 

Fentanyl 

Hydrocodone 

Hydromorphone 

Methadone 

Morphine 

Oxycodone 

Oxymorphone 

OPIOID MEDICATION RISKS 

• They can lead to dependence including problematic use and, 

in some cases, addiction. 

• For people in recovery from addiction, they pose a risk for relapse. 

• If you stop taking them suddenly, you can experience withdrawal. 

• Even when they work, they tend to only partly reduce pain. 

• In some people, they can make pain worse over time. 

• They have serious side effects, which include drowsiness and 

confusion, as well as bothersome side effects such as constipation. 

• They can cause overdose and death if not taken exactly as 

prescribed or if they are taken with certain other medications or 

substances, including alcohol or illicit drugs. 

19 
You have special responsibilities when taking opioids. 

Opioids are controlled substances, which means that there are strict 

laws regarding their prescription and use. It is illegal to give away, 

trade, share, or sell your opioid medication to anyone else. Also, if 

someone steals your opioids, you must report the theft to the police 

and to your doctor. 

Opioids can be dangerous.You should take them exactly as prescribed, 

because otherwise they can cause sickness and death. Also, it is very 

important that you keep opioid medications in a safe place away from 

children, teens, pets, and other adults. Every year people—especially 

children—die from taking opioids not prescribed to them. If you 

are prescribed opioids, ask your doctor to carefully explain your 

responsibilities for their safe use. 

I twisted my ankle playing 

tennis. Can I borrow some 

of your pain pills? 

No way, dude, sorry. In fact, we keep my pain 

pills locked up. I don’t even take them unless 

Nancy is standing there. That’s the agreement 

we worked out, to protect me from misusing. 

But my ankle hurts 

so bad! Give me 

just one.

 I can give you the 

name of my doctor. 

She’s really great. 

20 
Treatment agreements keep you and your care 

providers accountable to each other. 

If you are prescribed opioid medication, your care providers may 

write up a treatment agreement for you to sign. This is a written 

agreement that describes what you and your care providers expect 

from each other. The treatment plan may state what the care 

providers will do to manage and monitor your pain control. It 

may state the conditions under which you will receive the opioid 

medication. For example, it may state that you will have frequent, 

unscheduled urine drug screening tests. It may limit you to getting 

your prescriptions filled at only one pharmacy, put limits on 

refills, and set rules for replacing lost medication. The treatment 

agreement may state that there will be pill counts or patch counts 

at every visit, to help you make sure you are not taking too much of 

your medication or misusing it. It also may state that you give your 

doctor permission to speak with your other healthcare providers or 

with household members about your treatment. 

Doc, I fell and hurt my knee. It 

was really bothering me, so I took 

more of my neuralgia pills than I 

usually do, and I ran out early. 

Yeah, but it made 

sense, because my 

knee hurt so bad. 

We have a written agreement 

that you’ll take your medications 

only as prescribed. 

Increasing your neuralgia 

medication is not a good 

way to treat knee pain. 

Next time, please call 

me first as we agreed. 

Now, let me take a look 

at your knee. 

21 
The purpose of the treatment plan is to help keep you on track. 

Many people in recovery find it helpful to know that they are being 

held accountable and that their care providers are working with 

them to protect their recovery as well as their health and safety. 

Work with your care providers when going off opioids. 

People on opioid medication should discontinue taking it when 

the harm begins to outweigh the benefits. Of course, this statement 

applies to all medications, of whatever category. If you are taking 

opioids, your doctor will advise you how to taper off them, to avoid 

side effects. 

REASONS TO STOP TAKING OPIOID MEDICATION 

• The pain has decreased or disappeared. 

• The medication fails to relieve the pain or stops working. 

• The side effects are not worth the pain relief. 

• It is increasing cravings and putting recovery at risk. 

Prepare ahead for managing intense 

pain episodes. 

Acute pain is pain that comes on quickly and lasts for a limited 

time. This kind of pain can occur when you have surgery, are 

injured, have a spike in pain caused by disease, for many other 

reasons, and sometimes for no clear reason. It’s important to talk to 

your care providers about what to do if you ever experience acute 

pain. There are ways to treat it while minimizing the risk of relapse. 

This usually involves a combination of medication and active steps 

on your part, such as practicing relaxation techniques. 

If you already are on buprenorphine or methadone for opioid 

addiction, it’s important to know that the medication may help you 

with your chronic pain, but it is most likely not going to help with 

acute pain. In fact, buprenorphine can actually reduce the effect of 

other opioids you might take for acute pain. For this reason, it can 

be tricky to manage acute pain for patients in medication-assisted 

treatment.Your care providers may want to consult with an addiction 

specialist or other consultants with more experience with these 

medications used to treat addiction. 

22 
Take action immediately if you have a lapse 

in recovery. 

If you find yourself misusing your medication, noticing new or 

worsened psychiatric symptoms, or having cravings for alcohol 

or drugs, talk to your care providers or counselor immediately. 

Perhaps adjustments need to be made to your pain management 

activities and medications, so that you get better pain relief and stay 

solid in recovery. You may need more recovery support, such as 

more frequent visits to mutual-help meetings. Your care providers 

may be able to refer you to a treatment program that has more 

experience working with people in chronic pain. There are many 

different things that you can do to stay in recovery and manage your 

chronic pain. You, your care providers, and your mental health or 

addiction treatment counselor can explore them together. 

Pain management begins with you. 

It’s understandable that you want to get rid of your pain completely, 

but that is often not possible. Although you may always have some 

pain to manage, you can still improve your quality of life. You can 

manage your chronic pain. You can have a good life. 

Mine, too. Okay, one more 

time around the track— 

ready, set, go! 

I thought my life was 

over when the pain 

wouldn’t go away. 

Me, too. 

But that 

wasn’t true. 

My life is 

different than 

before—but 

it’s still 

good. 

23 
Resources 

American Academy of Pain Medicine 

Information about pain and a pain specialist locator 

http://painmed.org 

American Chronic Pain Association 

Peer support and education in pain management skills for people with pain 

http://theacpa.org 

American Pain Society 

Information about pain, public policy, and clinical practice 

http://americanpainsociety.org 

National Association of Cognitive–Behavioral Therapists (NACBT) 

NACBT-Certified Therapist Locator 

http://nacbt.org 

24 
This publication was developed as a collateral product to Treatment 

Improvement Protocol (TIP) 54, Managing Chronic Pain in Adults With or in 

Recovery From Substance Use Disorders. It was prepared for the Substance Abuse 

and Mental Health Services Administration (SAMHSA) by the Knowledge 

Application Program, a Joint Venture of The CDM Group, Inc., and JBS 

International, Inc., under contract number 270-09-0307, with SAMHSA, U.S. 

Department of Health and Human Services (HHS). Christina Currier served as 

the Contracting Officer’s Representative. 

All materials appearing in this document except those taken directly from 

copyrighted sources are in the public domain and may be reproduced or copied 

without permission from SAMHSA or the authors. However, this publication 

may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, HHS. 

The views, opinions, and content of this publication are those of the authors and 

do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. 

Two ways to obtain FREE consumer publications from SAMHSA’s 

Knowledge Application Program (KAP): 

1. Download or order from the SAMHSA Store at http://store.samhsa.gov. 

2. Call 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). 

Many KAP consumer publications are also available for download from 

the SAMHSA Store in additional languages: Cambodian (Khmer), 

Chinese, Korean, Russian, Spanish, and Vietnamese. 
You can manage your chronic pain to live a good life!

Work with your doctor 

to find the treatment 

that works for you.

Take active part in your 

pain treatment—it’s not 

just about medication!

Set goals about what you 

want to do, not about the 

pain itself.

Stick to your pain 

management plan.

Keep a positive 

attitude.

Work on your 

coping skills.

Enlist support 

from others. Safeguard your 

recovery.

Keep 

busy.

HHS Publication No. (SMA) 13-4783

Printed 2013