Additional considerations when assessing pain in people with known or suspected substance misuse

This section provides specific advice on assessing pain in people with known or suspected substance misuse and should be considered alongside the general approach to assessing pain described in this topic.

Assessing pain in a patient with known or suspected substance misuse, or a history of substance misuse, can be difficult. Accurate assessment can be hindered by stigma associated with substance misuse, pejorative attitudes of staff and discord between the patient and staff (especially if patients have had previous experiences of poorly managed pain). Establish good rapport to promote trust and understanding to allow for open discussion.

Early collaboration with an addiction medicine specialist may be required to optimise pain assessment and direct subsequent management.