Chronic Pain :: SUD. What is Actually Going On?

When evaluating a chronic pain patient, it is important to think beyond the pain-generating diagnosis and consider co-morbid conditions that may be present and have a direct impact on outcomes. While not exhaustive, the following list includes broad categories of patients presenting with pain complaints that should be considered in the differential:

1.     Chronic pain without any psychological/behavioral health or substance use disorders

2.     Chronic pain with a psychological/behavioral health disorder but without a SUD

3.     Chronic pain with a psychological/behavioral health disorder and at high risk for developing a SUD

4.     Chronic pain with Complex Persistent Opioid Dependence (CPOD)

5.     Chronic pain with an active SUD, but no other co-morbid psychological/behavioral health disorders

6.     Chronic pain with an active SUD, as well as additional co-morbid psychological/behavioral health disorder(s)

7.     Active SUD presenting as chronic pain (i.e. malingering as the drug-seeking behavior) 

8.     Chronic pain in a patient in stable recovery from a SUD

These broad categories can help guide patient evaluation and assist in determining the treatment plan and level of care the patient needs.