So, I primarily use pharmacotherapy to treat chronic pain. One of my main interests is using opioid therapy to its full potential in treating people with severe, intractable types of pain. Typically patients have already tried most other options. Opioids aren't magic. In one very successful case, a woman went back to school, became a legal secretary and went to work full-time.
Some people benefit very little.
There are some types of pain that are not opioid responsive. It is therefore important in the assessment process to consider the patient's risk factors for addiction. Part of my assessment and part of my decision-making about opioid therapy is to try and assess, as best I can, what the addictive risk is. Higher-risk people who have a legitimate pain problem in need of treatment may also benefit from opioids, but it requires much tighter supervision. People who are recovering from a recent addiction disorder need to have formal treatment and to be in an active, structured recovery program.