Management of pain in patients with comorbid substance use disorders can be challenging. Providers may be hesitant to use opioid analgesics in patients with a history of substance misuse or those currently receiving substance use disorder treatment. However, these patients may still experience pain and should have their pain adequately treated.

  • How does one treat pain in the setting of comorbid substance use disorders?1-9
  • What are the consequences of suboptimal pain control in the presence of substance use disorder treatment?10-12
  • How to manage pain in the perioperative and postoperative setting for those on medication assisted treatment for opioid use disorder?12-18

Reviewer 1: Mackenzie Pierce, PharmD, BCPS, BCPP
Reviewer 2: Carly Rainey, PharmD, BCPS, BCPP
Reviewer 3: Austin Smith, PharmD, BCPP
2023-2024 AAPP Resident and New Practitioner Committee


  1. Substance Abuse and Mental Health Services Administration. Managing chronic pain in adults with or in recovery from substance use disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. [Weblink]
  2. Chang Y-P, Compton P. Management of chronic pain with chronic opioid therapy in patients with substance use disorders. Addict Sci Clin Pract. 2013;8:21. DOI: 10.1186/1940-0640-8-21. PubMed PMID: 24341916; PubMed Central PMCID: PMC3904483.
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  9. Murphy L., Ng K., Shu V., et al. Approach to the pharmacological management of chronic pain in patients with an alcohol use disorder. J Pain Res. 2015;8: 851-857. [PubMed]
  10. Bounes V, Palmaro A, Lepeyre-Mestre M, Roussin A. Long-term consequences of acute pain for patients under methadone or buprenorphine maintenance treatment.  Pain Physician. 2013;16(6):E739-47. [PubMed]
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  12. Goel A, Azargive S, Lamba W, et al. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019;66(2):201-217. [PubMed]
  13. Mehta D, Thomas V, Johnson J, et al. Continuation of Buprenorphine to Facilitate Postoperative Pain Management for Patients on Buprenorphine Opioid Agonist Therapy. Pain Physician. 2020;23(2):E163-E174. [PubMed]
  14. Kohan L, Potru S, Barreveld AM, et al. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Reg Anesth Pain Med. 2021;46(10):840-859. [PubMed]
  15. Hickey T, Abelleira A, Acampora G, et al. Perioperative buprenorphine management: a multidisciplinary approach. Med Clin North Am. 2022;106(1):169-185. [PubMed]
  16. Schuster B, Bell B, Massoll A, White S. Continuation versus discontinuation of buprenorphine in the perioperative setting: a retrospective study. Cureus. 2022;14(3):e23385. [PubMed]
  17. Cornett EM., Kline RJ., Robichaux SL., et al. Comprehensive perioperative management considerations in patients taking methadone. Curr Pain and Headache Reports. 2019;23:1-9. [PubMed]
  18. Harrison TK, Kornfeld H, Aggarwal AK, Lembke A. Perioperative Considerations for the Patient with Opioid Use Disorder on Buprenorphine, Methadone, or Naltrexone Maintenance Therapy. Anesthesiol Clin. 2018;36(3):345-359. [PubMed]