Pain medicine and the opioid crisis: time to own our responsibility!

Abstract

Pain remains a major unmet health need. Rising opioid prescribing has not reduced population pain and has directly contributed to increased morbidity and mortality. Opioid use disorder (OUD) and pain frequently coexist. Many people with OUD experience acute and chronic pain and a substantial proportion of patients prescribed opioids develop OUD. We have contributed to this problem. In this Position Paper, we defend the idea that we must urgently redefine pain medicine as a frontline discipline in opioid use disorder prevention and recovery. Pain management must be reframed as part of the solution for people with or at risk of OUD. Core principles include: early identification of OUD and psychiatric comorbidity, routine incorporation of trauma-informed, stigma-reducing communication and shared decision-making; continuation of opioid agonist therapy during acute care; use of tailored multimodal, opioid-sparing analgesia; and perioperative planning with addiction and primary care follow-up. At a system level, we recommend multidisciplinary opioid stewardship, clear limits on opioid indication, dose and duration, diversion-mitigation strategies and policy changes such as reduced pack sizes and limiting indications for prolonged-released opioids. Research priorities include qualitative studies of lived experience, inclusion of patient-reported outcomes in trials and big-data analyses of prescribing to identify targets for intervention. Integrating clinical best practice, stigma-aware care and system reforms can reduce harm while ensuring equitable, effective pain relief for people with pain and those with or at risk of OUD.

Significance: This position paper synthesises clinical, psychosocial and system-level strategies to manage pain in people with or at risk of OUD. It emphasises our unique responsibility by learning from failures, and constructively sees the future. Treatment continuity, trauma-informed and stigma-reducing communication, integrated care, interdisciplinary coordination and opioid stewardship policies are no longer optional. These recommendations aim to reduce harms, improve pain and mental-health out-comes and guide clinicians and policymakers toward better and more equitable care.