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Patients with Pre-Existing Substance Use Disorders – Provider Resources

Managing pain among patients living with pre-existing substance use disorders (SUDs) or those recovering from SUDs is a sophisticated process and requires working with patients to create individualized treatment plans. The resources below provide information on conducting assessments and screening, recommended therapeutic approaches, and referrals for further treatment and information.

Pain Management of Patients with SUD

SAMHSA: A Treatment Improvement Protocol: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

  • Access this detailed 128-page Treatment Improvement Protocol (TIP) (TIP 54) for best-practice guidelines on the prevention and treatment of substance use disorders. Topics include: patient assessment, chronic pain management, managing addiction risk in patients treated with opioids, and patient education and treatment agreements.
  • Quick Guide for Clinicians: For a quick reference, access this 48-page guide for clinicians based on TIP 54 (full document link above).

Screening for Substance Use in the Pain Management Setting

  • Visit this site to access information on screening pain patients for substance use disorders and action to take if you receive a positive screen.

How to Guide for Primary Care Physicians: Treating Pain in Patients with a Substance Use Disorder

  • This article provides a foundation for expanding chronic pain guidelines in the area of treating patients with a substance use disorder. This summary serves as a how-to-guide for primary care physicians on risk assessment, patient stratification, and recommended therapeutic approaches.

Literature Review: Acute Pain Management in Opioid Dependent Patients

  • This article provides a review of literature on the management of acute pain in patients with long-term opioid agonists.

Stepwise Approach: Management of Acute Pain in the Patient Chronically Using Opioids

  • This resource will provide a stepwise approach to managing acute pain in patients chronically using opioids.

Challenges in Using Opioids to Treat Pain in Persons with Substance Use Disorders

  • This article discusses the clinical presentation of pain and its synergies with substance use disorders, evaluation and treatment of pain that co-occurs with substance use disorders, and provides guidelines for use of opioids to treat pain in patients with addiction.

Additional Resources


CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

  • Scroll down about half way to find a section titled “Patients with Substance Use Disorder” to learn more about prescribing recommendations.

Managing Pain in Patients with Substance Use Disorder

  • Visit this site to gain information on substance use disorders, SUDs in patients with cancer, and pain management in patients with SUDs.

For more information on pain management in people with a SUD, tailored toward patients and families: