Chronic Pain: Relief Without Ignoring the Risk of Problematic Use

The International Association for the Study of Pain reminds us that pain is a personal experience and a person's report of it should be taken seriously. Biological, psychological and social circumstances can affect pain; that does not make it imaginary. The absence of a simple explanation after an initial examination does not turn pain into a test of character.

It helps to ask where and how pain interferes, what has changed, what other conditions are present, and what has helped or caused harm. Sometimes the goal is less pain; sometimes it is also better sleep, movement or the ability to do things that matter. A person does not have to demonstrate productivity to deserve relief. New pain or a sharp change in familiar pain calls for a fresh assessment.

Persistent pain is a reason for a medical conversation, not a diagnosis of addiction. With regular use of some medicines, the body may adapt physically. Stopping abruptly can then cause withdrawal symptoms. The HHS clinician guide describes this in long-term opioid analgesic therapy. Adaptation and withdrawal alone do not prove a substance use disorder.

A professional evaluates a use disorder in a broader picture, including impaired control, harm and continued use despite consequences. Needing pain relief, receiving a prescription, fearing the return of pain or having one unexpected test result does not allow relatives to make that diagnosis. The reverse is also true: a prescription does not rule out problematic use. If the person says a medicine no longer helps, serious adverse effects have appeared, or they take it differently from the agreed plan, the response should be a calm clinical review of pain and safety, not punishment.

The FDA recognizes opioid medicines as an important option in appropriate circumstances while warning about risks, including overdose and use disorder. This is a class-wide safety communication, not a declaration that everyone with a prescription has a disorder. Risk can change with health, other medicines, available support and the course of treatment. It deserves repeated review, rather than a single judgment about someone's “type of person.”

The US CDC guideline of 2022 says prediction tools cannot reliably identify a person at zero risk. That is no reason for relatives to monitor someone covertly or secretly count tablets. It is more useful to discuss the actual benefit for pain and daily life, adverse effects, other substances and medicines, the patient's concerns and the next contact with the prescriber. When safety is at stake, that review should be accelerated. A treatment decision cannot be reduced to one number, questionnaire or relative's suspicion.

A useful appointment does not begin by forcing a choice between pain relief and safety. It asks both how to help the pain now and how to reduce harm from treatment or substance use. A clinician may revisit the cause and changes in pain, sleep and daily functioning, the tolerability of present treatment and other suitable options. A concern about substance use can be assessed without dropping the conversation about pain.

The CDC document addresses clinicians treating adult outpatients. Its opioid recommendations exclude pain related to sickle cell disease, cancer-related pain treatment, palliative care and end-of-life care. Even within its scope it calls for individual judgment and warns against mechanical denial of care. Prescribing rules and available options differ outside the United States. This guideline is neither worldwide law nor a ready-made medicine plan for an individual reader.

When a medicine helps but also raises concern, stopping it abruptly on one's own is not a test of “whether I am addicted.” For someone physically adapted to an opioid, abrupt cessation can worsen pain and cause withdrawal; a fast forced reduction can also harm. HHS and CDC ask clinicians to weigh benefit and risk with the patient while maintaining care. They do not say treatment must never change: serious harm or changed circumstances call for review.

Do not raise or lower a dose, switch to someone else's medicine or attempt a home “detox” based on this article. If a supply is running out, side effects appear or the plan has stopped working, contact the prescriber or another accessible medical service for timely assessment and continuity. If the first contact refuses help without assessing pain and risk, it is reasonable to ask for an explanation and another medical route that can actually be reached. None of this promises a particular prescription or delays emergency help when life is at risk.

Care may include medicines from different classes, attention to an underlying cause, movement or rehabilitation within a person's capacity, support for managing daily demands, and psychological methods. The options are combined or chosen according to the condition and the person's preferences. Psychological support does not mean the pain is “all in the mind”; physical approaches do not automatically replace everything else. Price, transport, language, time, contraindications and the availability of a professional all affect the real choice.

The CDC guideline recognizes differences between pain conditions and reports limited and inconsistent evidence for cannabis in painful conditions. Cannabis, psychotherapy, an opioid, or avoiding opioids cannot be declared a universal treatment. A “nonopioid” option is not automatically safe for a particular person. Ask what result is expected, when it will be reviewed and what happens if pain or harm increases. A plan can change with new information without making the patient a failure.

A diagnosis changes the risk assessment and plan; it does not erase pain. CDC explicitly says that a person with both pain and opioid use disorder still needs ongoing pain management coordinated with care for the disorder. One service may not handle both. Then a real handover between professionals matters, as does knowing who is responsible for the next appointment. A referral for addiction care is not pain relief already received.

A loved one may volunteer to listen, help someone reach an agreed appointment or write down questions if asked. They need not become a medicine guard or collect covert evidence. A child is not responsible for an adult's tablets, substance use or rescue in a crisis. If care for a child is disrupted now, a capable adult must actually take over; a call to a service is not supervision by itself.

If poisoning or overdose is suspected, contact the local emergency medical service immediately, even before symptoms appear: NHS guidance notes that they may develop later. Loss of consciousness, severe breathing difficulty, dangerous drowsiness or another immediate threat to life also needs emergency help. Do not wait for a diagnosis, a routine receptionist's answer or family agreement. New severe pain or a marked deterioration calls for urgent medical assessment; the local service can direct the route.

Where there are threats, violence or coercion, seek separate safe help and protection instead of starting with a joint conversation with a dangerous person. Urgent care for a child and actual handover of supervision do not wait for an adult's treatment plan. Rights, reporting duties, confidentiality and the help pathway depend on place; this article promises no identical outcome across countries.

A person could start with: “I have persistent pain. I need help with the pain and a review of the benefits and risks of my current treatment. I also have a concern about substance use or withdrawal. Who can assess me now and coordinate the next step?” Nobody has to explain their behaviour perfectly or stop pain treatment on their own before asking. If the present prescriber is unavailable, ask a local medical point of contact for a named person or service and a way to reach them.

Before sharing personal information, check whether the service accepts the person's age group, its language, cost and wait, how it handles an urgent review, whether the needed medicine or another type of care is available, who sees records, and who will connect pain care with substance-use care. Verify an actual appointment and handover, not just a directory listing. Help may take several steps, without a guaranteed result; pain and risk deserve attention from the first step.

• IASP: revised understanding of pain. Professional association statement of 16 July 2020; a person's pain report deserves respect, but this does not choose treatment.
• HHS: guide on reducing or discontinuing long-term opioid therapy. US clinician guide, October 2019; long-term opioids for chronic pain, not a home withdrawal schedule.
• FDA: safety of opioid pain medicines. US regulator communication, 13 April 2023; recognizes therapeutic use and risks without diagnosing anyone from a prescription.
• CDC: Clinical Practice Guideline for Prescribing Opioids for Pain. US clinician guideline of 4 November 2022 for adult outpatients; excludes sickle cell disease-related pain, cancer-related pain treatment, palliative and end-of-life care; neither foreign law nor a personal plan.
• NHS: Poisoning. UK medical information reviewed 12 June 2025; suspected poisoning needs help before symptoms, and local emergency numbers must be checked locally.

This is an original, narrow synthesis of the passages read, not a scale, diagnostic list, medication instruction or comprehensive review of pain treatment. These sources cannot diagnose an individual reader, establish local service availability or promise a universal legal outcome.

chronic pain; pain relief; opioids; physical adaptation; withdrawal; substance use disorder; safety; treatment; choice; support; access to care; emergency help.

Andrey Zarinsh — author and founder of United Wisdom. He explores inner transformation, the unity of traditions, intercultural dialogue, and contemporary spiritual discipline. Instagram: @andrey.zarinsh.

Maria Evilkut — co-author of United Wisdom. Alongside her research, she seeks to test these ideas in practice and observe how principles of unity and mutual understanding work in real life between people and cultures. Instagram: @ilkutki.

15 October 2026. English version.