Chronic pain in substance use and addictive behaviours

Chronic pain is a common comorbidity in people with a disorder of opioid use, pregabalin or gabapentin use or cannabis use.

The Pain and Analgesia guidelines provide advice on the role of opioids in chronic noncancer pain and the role of adjuvants for chronic noncancer pain. Consider ways to reduce opioid use (eg weaning [deprescribing] or medication-assisted treatment of opioid dependence) for all patients with chronic pain because of the risk of harms (even when the person is adhering to the prescriber’s advice) and seek specialist advice for complex situations.

It can be challenging to assess whether a patient with chronic pain has a disorder of substance use. A possible or known disorder of substance use in a patient with chronic pain is an indication for specialist advice or referral to evaluate the options for weaning medications or medication-assisted treatment of opioid dependence. Key resources has links to clinical advisory services on substance use referral information for state- and territory-based services.

Some patients use cannabinoids (cannabis products derived from plants or synthetic forms of cannabis) for management of chronic pain, but cannabinoid use is associated with a risk of developing a disorder of substance useGilman, 2022. For advice on the use of cannabinoids in chronic pain, see Cannabinoids.

Consider alternative pain management strategies with specialist advice if planning any substance withdrawal for patients with chronic pain.