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Chronic pain and addiction are deeply connected, oftentimes fueling each other in a vicious cycle. Someone in constant pain may turn to opioids or alcohol for relief; yet, paradoxically, long-term and problematic substance use often ends up worsening pain. A recent scientific study offers fresh insight into this dangerous connection, underscoring why tackling chronic pain and substance use disorder (SUD) together is crucial.[1]
The study: Pain pushes people toward drugs
A 2025 analysis of 980 U.S. adults in NHANES 2009-10 asked who was living with ongoing pain (≥ 6 weeks). Results were proportional with drug use:[1]
- Of the people who used no drugs, about 19% lived with chronic pain.
- Of the people who used only one drug, roughly 23% had chronic pain.
- Of the people who used multiple drugs, nearly 39% were in ongoing pain.
After controlling for age, sex, and income, ongoing pain predicted 1.36 times higher odds of single-substance use and 3.06 times higher odds of polysubstance use versus those without chronic pain.
The more pain someone has, the more substances they tend to use, even after demographic confounders are removed.
When drug use makes pain worse
The same dataset shows the flip side: problematic drug habits can intensify pain. Compared with people who don’t use drugs, those who use one substance were about one-third more likely to report chronic pain, and those who engage in polysubstance abuse were roughly three times more likely.[1]
Thus, drug misuse doesn’t just follow pain—it can prolong or amplify it, locking people into the very cycle they were trying to break.
Why pain & substance use intertwine
Why do chronic pain and substance use frequently go hand in hand? One primary reason is that people in pain desperately seek relief. Chronic pain is relentless and draining, and many turn to whatever offers comfort, including alcohol, opioids, other prescription medications, or illicit drugs. Chronic pain can push people toward “self-medicating” with substances to dull the physical pain or emotional distress it causes.[1] Over time, this behavior may spiral into addiction, as tolerance and dependence build.[1]
For example, someone with back pain might start taking opioids as legitimately prescribed but end up taking higher doses or mixing in alcohol to have more relief. [1] This pattern is perilous; using multiple substances or more medication than prescribed significantly raises the risk of overdose and other serious consequences.[1]
Chronic pain oftentimes comes with psychological distress, heightening the risk of addiction. Depression and anxiety commonly accompany persistent pain. These emotional challenges can drive individuals to misuse drugs as a way to cope or seek relief. About half of those with substance use disorders also experience chronic pain.[2]
Moreover, higher pain levels in people recovering from addiction have been linked to worse treatment outcomes.[3] It can be, and is, a negative spiral: pain causes despair that tempts a person to use drugs, but drug misuse then adds new health and life problems that often intensify the pain and distress.
There are biological ties between pain and addiction as well. Chronic stress is a common denominator; unrelenting pain stresses the body, and long-term substance misuse also triggers stress responses. This stress can sensitize the nervous system and amplify pain.[4]
Bidirectional impacts
The relationship between chronic pain and addiction is bidirectional, meaning it works both ways. On one side, chronic pain can be a gateway to addiction. Many opioid addictions begin with a legitimate pain treatment that unexpectedly escalates.
Apart from this study, another study found that many patients with opioid use disorder traced their problem back to attempts to manage pain. For some, the constant stress of living with pain may also trigger an underlying predisposition to substance misuse, tipping them into addiction.[2]
Conversely, substance misuse can cause or worsen chronic pain. Severe addictions frequently result in injuries or health problems that lead to persistent pain.[2] Additionally, certain drugs alter pain perception. Paradoxically, heavy opioid use can increase pain sensitivity, rather than relieve it.
Breaking the cycle: Managing chronic pain without substance misuse
Breaking the pain-addiction cycle starts with managing chronic pain safely, without over-reliance on addictive substances. Many pain management strategies can control pain while minimizing the risk of addiction. For physical conditions, doctors often recommend non-opioid pain relievers (such as acetaminophen or NSAIDs), along with non-pharmacologic treatments (like physical therapy, exercise, or acupuncture), in order to reduce pain without heavy drug use. This is called multimodal analgesia, and the aim is for the patient not to rely too heavily on opioids.
Behavioral and psychological approaches are also critical. Cognitive-behavioral therapy (CBT) and similar programs teach patients to manage pain by reducing stress, reframing negative thoughts, and practicing relaxation techniques. One clinical trial found that adding a pain-management intervention to addiction treatment improved patients’ pain tolerances and reduced their pain levels, even if it didn’t significantly change relapse rates.[5] These results show that pain relief and a better functional status are achievable without misusing drugs.
Patients and healthcare providers should also communicate openly about pain and any substance use history. Doctors can then plan treatments, using the lowest effective opioid dose only when necessary and exploring non-addictive alternatives.
Prevention and early intervention
- Preventing the pain-addiction cycle from taking hold is a priority. Doctors are encouraged to integrate pain management with mental health and addiction care.[1]
- Early action is crucial. Routine screening of patients who experience chronic pain for any risk of substance misuse (and vice versa, checking for untreated pain in those with SUD) can enable support before problems escalate.
- Another step is setting realistic expectations and developing healthy coping skills. Patients should understand that chronic pain may not entirely disappear, but it can be effectively managed to improve their quality of life.
- Learning coping techniques early, through counseling, physical rehabilitation, or support groups, can prevent someone from turning to alcohol or drugs when pain flares up. Loved ones can also help by encouraging proper treatment and watching for warning signs of substance misuse.
- Research also suggests that fostering psychological flexibility (the ability to adapt to pain and stress) can protect mental well-being in people with chronic pain, even when they face substance use challenges.[6]
Looking ahead, experts stress the need for better pain treatments that don’t feed addiction. Research is exploring non-opioid medications, nerve stimulation therapies, and other innovations to relieve chronic pain safely.
Resources for patients and families
If you or a loved one is dealing with chronic pain and potential addiction, remember that you are not alone and help is available. Here are some reputable resources for support and information:
- SAMHSA’s National Helpline (1-800-662-HELP): A free, confidential 24/7 service that provides treatment referrals and information for individuals and families facing substance use disorders.[7]
- American Chronic Pain Association (ACPA) & U.S. Pain Foundation: Non-profit organizations that offer education, coping resources, and peer support. They provide tools and support group directories.
- Integrated pain management programs: Many hospitals offer multidisciplinary pain programs that combine medical, physical, and psychological therapies. These programs help patients manage pain without heavy reliance on opioids.
Final thought
As we can see from the study, chronic pain and addiction are tightly linked, but with the right strategies, it’s possible to break the destructive cycle. By understanding how each condition fuels the other, we are better equipped to treat the individual as a whole. With early intervention, safer pain treatments, and support, those in pain can find relief without falling into addiction, and those in recovery can heal without being pulled back by pain.
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