Chronic pain can affect far more than how the body feels. It can change sleep, movement, concentration, mood, work, relationships and the confidence to make plans.
When pain continues for months or years, it is understandable to want something strong enough to make it stop. For many people, that is where opioid pain medicines first become part of the treatment plan.
Opioids can have an important medical role in selected situations, but they are not the only way to treat pain and they are not automatically the best long-term treatment for chronic pain. Modern chronic-pain management increasingly focuses on identifying the type of pain, improving function and combining several treatments rather than relying on one medication.
Managing chronic pain without opioids does not mean telling somebody to simply tolerate pain. It means building a treatment system around the person’s condition.
That system may combine physical rehabilitation, exercise, nonopioid medication, sleep treatment, cognitive behavioral therapy, pain psychology, specialist procedures and practical changes to everyday life.
For somebody who already takes opioids regularly, the answer should not normally be to stop them suddenly. Long-term opioid treatment can produce physical dependence, and rapid discontinuation may cause withdrawal and other harms. Any reduction should be individualized and discussed with the prescribing clinician.
There is also an important group of patients whose chronic pain has become connected with opioid dependence or opioid use disorder. In those situations, pain treatment and addiction treatment need to be planned together.
Naltrexone — including long-acting formulations in appropriate patients — may sometimes be part of the opioid-recovery side of that plan.
It is important to understand the distinction: naltrexone is not a conventional painkiller. It blocks opioid receptors. While an effective blockade is present, opioid pain medicines may not work normally. A patient considering long-acting naltrexone therefore needs a credible nonopioid pain strategy as well as an addiction-recovery plan.
This guide explains how to build a practical nonopioid chronic-pain plan, how different treatments work, what to do during pain flares, what to consider if you already take opioids, and where long-acting naltrexone may fit when chronic pain and opioid dependence overlap.
How chronic pain works, which nonopioid treatments may help, how to create a pain-management plan, how to respond to pain flares, and how opioid-dependence treatment can be incorporated without ignoring the underlying pain.
Prepared for medical review by Dr. Fergus Law, BSc, MBChB, FRCPsych
Consultant Psychiatrist specialising in substance misuse and addiction psychiatry
Review status: Pending clinical approval
View Dr Fergus Law’s Clinical & Scientific Profile →What Is Chronic Pain?
Chronic pain is commonly defined as pain that persists or recurs for longer than three months.
That definition sounds simple, but chronic pain is not always simply acute pain that has lasted longer.
Over time, the experience of pain can be influenced by the nervous system, movement patterns, inflammation, sleep, stress, mood, expectations, previous injury and a person’s social environment.
The International Association for the Study of Pain describes chronic pain as multifactorial. Biological, psychological and social factors can all contribute.
That does not mean that pain is imaginary. Pain is a real experience. It means there may be several useful treatment targets rather than one damaged structure that can be solved by increasing medication.
Acute Pain
Usually begins suddenly and is often connected with an injury, operation, inflammation or another identifiable event. It commonly improves as the underlying problem heals.
Subacute Pain
Pain continuing beyond the initial acute phase but not yet meeting the usual chronic-pain timeframe. This can be an important stage for preventing longer-term disability.
Chronic Pain
Pain persisting or recurring for more than three months. Treatment often focuses on pain reduction together with restoring function, confidence and participation in life.
Pain Intensity Is Only One Part of the Problem
A pain score can be useful, but chronic-pain treatment normally needs wider goals.
Two people can both describe their pain as 7 out of 10 while experiencing very different levels of disability.
One may still be working, walking and maintaining relationships. Another may be spending most of the day in bed, sleeping poorly, avoiding movement and becoming socially isolated.
Instead of asking only, “How do I make the pain number lower?” also ask, “What would I like to be able to do more easily if my pain was managed better?”
Functional goals might include walking for 20 minutes, returning to work, sleeping for longer periods, cooking a meal, driving, exercising, playing with children, attending a social event or reducing the number of days lost to pain flares.
Why the Nervous System Matters
Pain is a protective experience produced through the nervous system.
In some long-lasting pain conditions, the pain system can become more sensitive. Signals that previously produced little discomfort may begin to feel more threatening or intense.
This is one reason why the amount of pain somebody experiences does not always correspond perfectly with what can be seen on a scan.
The practical message is not that tissues do not matter. It is that chronic pain can involve several interacting systems.
That creates multiple treatment targets: strength, mobility, sleep, stress, inflammation, neuropathic pain, fear of movement, mood, medication effects and nervous-system sensitization.
Read the IASP Chronic Pain Definition →Understanding Persistent Pain
Tame the Beast, narrated by pain scientist Professor Lorimer Moseley, is an educational explanation of persistent pain and why understanding, gradual movement and whole-person treatment may be useful.
Educational resource featuring Professor Lorimer Moseley. Video education does not replace an individual medical assessment.
Explore Tame the Beast →Why Manage Chronic Pain Without Opioids?
The goal of non opioid pain management is not to claim that opioids are always wrong.
Opioids can be medically appropriate in selected situations, including some severe acute pain, cancer-related pain, palliative care and selected chronic-pain cases.
The important question is whether expected benefit for a particular person outweighs the risks and whether appropriate alternatives have been properly considered.
Current CDC guidance states that nonopioid therapies are preferred for subacute and chronic pain and that clinicians should maximize nonpharmacologic and nonopioid pharmacologic treatment appropriate to the patient’s condition.
What Are the Risks of Long-Term Opioid Therapy?
Risk depends on the drug, dose, duration, other medications, medical conditions and the individual patient.
Potential problems can include sedation, constipation, impaired driving, falls, respiratory depression, physical dependence, withdrawal after rapid reduction, overdose and opioid use disorder in some patients.
Tolerance can also develop to some opioid effects, meaning the same dose may provide less of the desired effect over time.
In some patients, increasing doses can therefore increase risk without producing a comparable improvement in everyday function.
CDC guidance recommends nonopioid therapies for subacute and chronic pain and also warns against abruptly stopping or rapidly reducing long-term opioids unless there is an immediate life-threatening concern.
Managing Pain Without Opioids Does Not Mean Managing Pain Without Medication
“Nonopioid” is a broad category.
Depending on the diagnosis, some patients may benefit from anti-inflammatory medicines, acetaminophen, selected antidepressants, selected anticonvulsants or topical treatments.
Other patients may gain more benefit from physical rehabilitation, cognitive behavioral therapy, sleep treatment, weight management, specialist procedures or a multidisciplinary pain program.
The strongest strategy is generally not simply: “replace opioid A with tablet B.”
It is to combine treatments addressing the mechanisms and consequences of that person’s pain.
Identify the Type and Cause of Pain
Chronic pain is not one disease.
A treatment that helps osteoarthritis may do little for diabetic neuropathy, migraine, fibromyalgia or spinal nerve pain.
Before building a chronic pain treatment without opioids, ask whether the diagnosis is clear and whether current treatment actually matches the type of pain.
Muscle, Joint or Tissue Pain
Pain involving ongoing activation of pain-sensing pathways in tissues, such as some forms of osteoarthritis or musculoskeletal pain.
Depending on the diagnosis, treatment may include exercise, rehabilitation, anti-inflammatory strategies, weight management or selected procedures.
Nerve-Related Pain
Pain associated with a lesion or disease affecting the somatosensory nervous system.
It may be described as burning, electric, shooting, tingling or associated with numbness.
Altered Pain Processing
Some conditions involve altered nociception or a mixture of mechanisms rather than one clearly injured structure.
Treatment may need to address movement, sleep, stress, pain processing and function together.
A Good Assessment Looks Beyond the Scan
Imaging can be extremely important when there is a clinical reason for it, but scans do not always explain the severity of chronic symptoms.
Medical history, physical examination, neurological findings, the symptom pattern, laboratory tests when relevant and the person’s level of function all help create the clinical picture.
- What is the most likely diagnosis causing or maintaining my pain?
- Is the pain primarily musculoskeletal, inflammatory, neuropathic, nociplastic or mixed?
- Is there anything reversible that has not been addressed?
- Which treatments have evidence for my particular condition?
- What should we measure besides pain intensity?
- Should we track walking, sleep, work, strength or flare frequency?
- Do any of my current medicines increase sedation, dependence or fall risk?
If the diagnosis has never been reassessed, symptoms have changed, or treatment has continued for years without meaningful improvement, a fresh clinical review may be more valuable than simply increasing medication.
Nonopioid Medications for Chronic Pain
Nonopioid medicines can be useful, but they are not interchangeable and they are not risk-free.
The best choice depends on the pain condition, age, kidney and liver function, cardiovascular history, gastrointestinal risk, other medication and the person’s overall health.
This section is educational rather than a prescribing guide. A clinician or pharmacist should assess individual suitability, interactions and dosing.
NSAIDs
Medicines such as ibuprofen or naproxen may help selected musculoskeletal and inflammatory pain conditions.
Topical NSAIDs may be useful for some localized pain and may reduce systemic exposure compared with tablets.
IMPORTANTOral NSAIDs can increase gastrointestinal, kidney and cardiovascular risks in some patients.
Acetaminophen
Acetaminophen may be considered for selected pain conditions, including when NSAIDs are unsuitable.
IMPORTANTExcessive total intake can cause serious liver injury. Combination medicines can also contain acetaminophen, so the total amount from all sources matters.
Selected Antidepressants
SNRIs such as duloxetine and some tricyclic antidepressants may be used for selected neuropathic pain, fibromyalgia or other chronic-pain conditions.
IMPORTANTThese medicines are not used because the pain is imagined. They can influence nervous-system pathways involved in pain processing.
Selected Anticonvulsants
Medicines such as gabapentin or pregabalin may be considered for some forms of neuropathic pain.
IMPORTANTBenefit is condition-specific. Sedation, dizziness and dependence or misuse concerns in some populations should also be considered.
Topical Lidocaine or Capsaicin
Local treatments can sometimes be useful for selected localized or neuropathic pain conditions while reducing systemic medication exposure.
IMPORTANTEffectiveness varies according to the diagnosis and correct application matters.
Condition-Specific Treatment
Migraine, inflammatory arthritis, osteoporosis, endometriosis and other conditions may require treatment directed at the underlying disease rather than generic pain suppression.
IMPORTANTTreating the underlying problem may be more valuable than repeatedly adding another general pain medicine.
Nonopioid medication should be selected because it matches the pain mechanism or condition — not simply because it is “not an opioid.”
Physical Therapy, Exercise and Movement
When movement hurts, avoiding movement can feel logical.
Short periods of protection may be appropriate during an acute injury, but long-term avoidance can contribute to weakness, reduced fitness, stiffness, fear and loss of confidence.
For several common chronic pain conditions, appropriately designed exercise is part of treatment rather than something to wait for until all pain has disappeared.
Start With the Right Dose of Movement
The phrase “just exercise more” is not a treatment plan.
The starting level should be realistic. A person who has become deconditioned over several years may need to begin with minutes rather than an hour.
Activity can then be progressed according to symptoms, function and clinical advice.
Choose an amount of movement that is achievable without repeatedly producing major setbacks.
Build a predictable routine rather than alternating between overactivity and complete rest.
Increase time, resistance, distance or complexity in small steps when appropriate.
Track what you can do, not only the pain score immediately after activity.
The Boom-and-Bust Cycle
A common pattern is to do very little during a bad period, feel slightly better, attempt to catch up on everything at once, then experience another flare and return to prolonged rest.
This can make physical activity unpredictable and reinforce the belief that movement is dangerous.
Pacing attempts to replace this with a more stable level of activity that can gradually increase.
When Physical Therapy Can Help
Physical therapists can assess strength, range of motion, walking, balance, movement patterns, fear of movement and practical barriers to activity.
Treatment may include exercise therapy, education, graded exposure, selected manual techniques and a home program.
Read the AHRQ Nonpharmacologic Pain Review →CBT, Mindfulness and Pain Psychology
Psychological treatment for chronic pain is sometimes misunderstood as a clinician saying that the pain is “all in your head.”
That is not its purpose.
Pain psychology starts from the fact that the pain is real and asks which skills can reduce disability, fear, distress and the amount of life disrupted by pain.
Change the Response, Not the Reality
CBT can help identify patterns such as catastrophizing, all-or-nothing activity, fear of movement and avoidance.
It may also include relaxation, pacing, problem-solving, activity scheduling and sleep skills.
Reduce the Struggle Around the Sensation
Mindfulness-based approaches may help some people notice pain and distress without automatically escalating into panic, muscular tension or complete avoidance.
What About Acceptance and Commitment Therapy?
Acceptance-based pain treatment does not mean giving up.
It focuses on reducing the amount of life postponed until pain disappears.
A person identifies what matters — family, independence, work, creativity, fitness or social connection — and begins taking manageable actions toward those values while symptoms continue to be treated.
From:
“I will start living again when the pain is completely gone.”
To:
“How can treatment help me build more life while we continue
working on the pain?”
Treatment can still be successful when the person sleeps better, moves more, works more consistently, needs fewer rescue interventions and feels less controlled by pain — even if the pain has not disappeared completely.
Explore Evidence for CBT and Other Nonpharmacologic Treatments →Sleep, Stress and Daily Routine
Chronic pain and poor sleep can reinforce each other.
Pain can make it difficult to fall asleep or stay asleep, while poor sleep may increase fatigue, irritability, distress and sensitivity to pain the next day.
For many patients, treating sleep is therefore part of pain management rather than a lifestyle extra.
Build a More Predictable Sleep Pattern
A clinician may need to consider insomnia, sleep apnea, restless legs, medication effects, alcohol use, anxiety or depression.
Behavioral treatment for insomnia may be useful and can avoid simply adding another sedating medicine to an already complex medication regimen.
Regular sleep timing can help stabilize the sleep-wake cycle even after a difficult night.
Appropriate activity may support sleep and reduce physical deconditioning.
Long or late naps can make nighttime sleep harder for some people.
Several medicines can interact to increase sleepiness, fall risk or respiratory risk.
Stress Does Not Mean the Pain Is Psychological
Stress can influence muscle tension, sleep, attention, mood and the autonomic nervous system.
Many people notice that pain becomes harder to manage during conflict, financial pressure, bereavement or prolonged anxiety.
Recognizing this does not blame the person for the pain. It identifies another factor that may be treatable.
Food, Weight and General Health
There is no single universal “chronic pain diet.”
Nutrition advice should match the patient’s health and diagnosis. For some conditions, reducing excess weight may reduce mechanical load on painful joints.
Diabetes management may matter for neuropathy. Smoking cessation can improve general health and may matter for surgery and tissue healing.
This is another example of treating the whole context rather than searching for one universal supplement.
Specialist and Interventional Options
Some pain conditions need more than primary-care medication and exercise advice.
Referral may be considered to a pain specialist, neurologist, rheumatologist, orthopedic specialist, rehabilitation physician or another clinician appropriate to the diagnosis.
Interventional Pain Procedures
Depending on the diagnosis, specialists may consider targeted injections, nerve blocks, radiofrequency procedures, neuromodulation or other interventions.
Evidence and suitability vary substantially between conditions.
Multidisciplinary Pain Programs
These programs may combine medical care, physical rehabilitation and psychological treatment around shared functional goals.
Be Careful With the “One Procedure Will Fix Everything” Promise
Chronic pain can make people vulnerable to expensive treatments marketed with certainty.
Before an intervention, ask what diagnosis is being targeted, what improvement is realistic, how long benefit commonly lasts, what risks exist and what the next step will be if it fails.
- What specific pain mechanism are we targeting?
- What evidence exists for my condition?
- Is the goal pain reduction, improved function, diagnosis or all three?
- What are the important risks?
- Will physical rehabilitation still be needed afterward?
How to Build a Nonopioid Chronic Pain Management Plan
A useful plan should be specific enough to use on an ordinary Tuesday morning — not only during a medical appointment.
It should connect treatment with real-life goals and define what happens when symptoms improve, stay the same or flare.
Define the Diagnosis and Functional Goal
Write down the working diagnosis and one to three things you want treatment to help you do.
Examples include walking 30 minutes, returning to work, sleeping for six hours or reducing the number of days spent in bed after a flare.
Choose the Core Daily Treatments
Decide which treatments need consistency: physiotherapy exercises, walking, prescribed medication, sleep routine, CBT skills, stretching or another clinician-recommended treatment.
Separate Daily Treatment From Rescue Treatment
Daily strategies build stability. Rescue strategies are used for temporary flares.
Confusing the two can contribute to medication overuse or complete activity avoidance whenever symptoms rise.
Track Function, Sleep and Flares
Do not measure only pain scores.
Also track walking distance, work hours, sleep, rescue-medication use, missed activities and the duration of pain flares.
Review Medicines and Dependence Risk
Ask a clinician or pharmacist to review opioids, sedatives, gabapentinoids, sleep medicines, alcohol use and combinations that may increase sedation or overdose risk.
Create a Flare and Safety Plan
Decide what a familiar flare looks like, what treatments you will use first, who you will contact if it does not improve and which symptoms require urgent assessment.
A pain plan should make treatment more predictable. You should know what you are doing every day, what you are measuring and what the next step will be if the current plan is not working.
Chronic Pain Management Plan Example
This example shows how several treatment components can work together.
It is not a prescription and should not be copied without clinical assessment.
Chronic Low Back Pain, Poor Sleep and Long-Term Opioid Use
Pain for three years, reduced walking, poor sleep, repeated flares and daily prescription opioid use.
Walk for 25 minutes on most days and return to two regular social activities each week.
Physiotherapy assessment, a short daily walking baseline and progressive strengthening rather than waiting for a completely pain-free day.
Clinician reviews the diagnosis, opioid benefit, adverse effects and nonopioid options.
Consistent wake time, insomnia assessment and CBT-based pain work addressing pacing and fear of movement.
Temporarily reduce activity without prolonged bed rest, follow agreed nonopioid measures and contact the clinical team if symptoms are unusual.
Determine whether the patient has expected physical dependence, problematic opioid use or opioid use disorder.
Discuss evidence-based medications for opioid use disorder. If naltrexone is considered, an adequate opioid-free period and an alternative pain-management plan are essential.
Notice that the example does not define success only as “zero pain.”
Treatment also aims to improve function, sleep, confidence and safety while continuing to address the pain.
When Chronic Pain and Opioid Dependence Overlap
A patient can take an opioid exactly as prescribed and still develop physical dependence.
Physical dependence means the body has adapted to the medicine and withdrawal can occur if the drug is suddenly stopped.
That is not automatically the same as opioid use disorder.
Opioid use disorder involves a problematic pattern of opioid use associated with clinically significant impairment or distress.
The Body Has Adapted
Withdrawal may occur if the medication is abruptly stopped.
This can happen even when a patient has taken the medicine exactly as prescribed.
A Broader Pattern of Problems
OUD is a medical diagnosis involving problematic opioid use causing meaningful impairment or distress.
It requires its own treatment plan.
Do Not Turn a Pain Patient Into a Withdrawal Patient Overnight
CDC guidance advises against abrupt discontinuation or rapid dose reduction in patients already receiving long-term opioids unless there is a life-threatening issue requiring immediate action.
For some long-term patients, dose reduction can take months or longer and may need pauses or adjustments.
At the same time, continuing an opioid simply because reducing it is difficult is not a complete pain-management strategy.
Nonopioid treatments can be developed while the clinical team reassesses whether opioid treatment is still improving function enough to justify its risks.
If you take opioids regularly, do not stop them suddenly or attempt to start naltrexone yourself. Naltrexone can precipitate severe withdrawal in somebody who remains physiologically dependent on opioids.
Where Naltrexone May Fit When Chronic Pain and Opioid Dependence Overlap
Naltrexone can become relevant when the problem is no longer only chronic pain, but also opioid dependence or opioid use disorder.
It should not be presented as a conventional treatment for the underlying chronic pain itself.
Naltrexone is an opioid-receptor antagonist.
Standard naltrexone is an established medication used in the treatment of opioid use disorder and alcohol use disorder.
By occupying opioid receptors, it blocks or substantially reduces opioid effects while an adequate blockade is present.
That can be useful for a person whose recovery goal includes remaining opioid-free.
But the same mechanism means that opioid pain medicines can be blocked.
A person with chronic pain considering naltrexone therefore needs a credible nonopioid pain strategy before treatment, not after.
Support treatment of opioid use disorder by blocking opioid effects and reducing opioid craving in some patients while treatment is active.
It does not repair a painful joint, treat spinal degeneration, reverse neuropathy or function as a conventional opioid-like analgesic.
If opioid analgesia is blocked, chronic and acute pain need alternative strategies appropriate to the patient’s condition.
A physically opioid-dependent patient must be adequately opioid-free before naltrexone begins. The treating medical team determines the preparation required.
Long-Acting Naltrexone and Naltrexone Implants
Long-acting delivery can reduce the need to remember a tablet every day.
In the United States, the FDA-approved long-acting naltrexone formulation for opioid use disorder is extended-release intramuscular naltrexone.
Implantable sustained-release naltrexone products have been studied and are used in some jurisdictions, but regulatory status, duration, formulation, dose and evidence are product-specific.
Naltrexone implants are not FDA-approved in the United States.
For a patient with chronic pain and opioid use disorder, a long-acting antagonist strategy may make sense only when another important question has been answered:
How will this person’s chronic and emergency pain be managed safely without relying on opioid analgesia?
What Happens if Emergency Pain Treatment Is Needed?
Current FDA prescribing information for extended-release naltrexone recommends regional analgesia or nonopioid analgesics as suggested approaches when emergency pain treatment is needed during active blockade.
If opioid analgesia becomes unavoidable, the situation can be clinically complex and requires appropriately trained medical professionals and close monitoring.
Patients receiving long-acting naltrexone should tell surgeons, dentists, emergency clinicians and other prescribers that opioid receptors may be blocked.
Planned surgery should be discussed with the treating team in advance whenever possible.
Do Not Confuse a Long-Acting Implant With Low-Dose Naltrexone
Low-dose naltrexone is an off-label strategy being investigated for some pain conditions.
That is a different concept from using sustained-release antagonist treatment for opioid use disorder.
Evidence, dose, intended effect and clinical decision-making are different.
Research into low-dose naltrexone should therefore not be used as proof that a long-acting implant treats chronic pain.
When chronic pain and opioid addiction overlap, long-acting naltrexone may support the opioid-recovery component of treatment while the pain itself is managed through a separate multimodal nonopioid plan.
Could Long-Acting Naltrexone Fit Your Recovery Plan?
DeBinge can provide an educational consultation about long-acting naltrexone, preparation requirements and recovery planning.
Suitability must be determined through individual medical assessment. Naltrexone does not replace assessment and treatment of the underlying chronic-pain condition.
What to Do During a Chronic Pain Flare
A flare is a temporary increase in pain or related symptoms.
Some flares follow obvious triggers such as unusual activity, illness, poor sleep or stress.
Others occur without an obvious reason.
A written flare plan reduces the number of decisions somebody must make while already distressed by pain.
Is the flare similar to previous episodes, or is there a genuinely new symptom, injury or neurological change?
Temporarily scale activity to a tolerable level unless your clinician has advised rest for a specific medical reason.
Follow the medication, positioning, relaxation, heat/ice or movement plan agreed with your clinician.
Try not to allow one difficult day to completely reverse sleep timing, meals, movement and social contact.
Consider unusual activity, poor sleep, stress, missed medication or illness that may help explain the flare.
Contact your clinical team when pain is unusually severe, prolonged or accompanied by new concerning symptoms.
Do not only ask, “What made the pain worse?” Also ask, “What helped me recover more quickly this time?”
How Family and Support Can Help
Chronic pain affects families as well as patients.
Partners and relatives may become frightened by pain, take over tasks, encourage complete rest, become frustrated by cancelled plans or focus every conversation on symptoms.
These reactions may be understandable but can sometimes unintentionally increase disability or conflict.
Support Function, Not Just Symptom Monitoring
Useful support might mean joining a short walk, helping with transport to physiotherapy, protecting sleep routines, encouraging planned activity or helping somebody follow the flare plan without panic.
“What Does Your Plan Say to Do Today?”
This supports independence and the person’s established treatment plan.
“You’re in Pain, So You Should Do Nothing.”
Unless there is a specific reason for rest, repeatedly reinforcing complete avoidance can make returning to normal activity harder.
If Opioids Are Still Being Used
Families should understand overdose risk, particularly when opioids are combined with alcohol or other sedating medicines.
If a clinician recommends keeping naloxone available, household members should know where it is and how to respond to a suspected overdose.
If opioid use has become uncontrolled, families should encourage professional treatment rather than attempting to supervise an unsupervised detoxification themselves.
When Chronic Pain Needs Urgent Medical Attention
Most chronic-pain flares are not medical emergencies.
However, a person should not automatically assume every new symptom is “just the chronic pain.”
Seek urgent medical assessment for new or severe symptoms such as:
- New loss of bladder or bowel control associated with back pain or new numbness around the saddle/genital area.
- New major weakness, paralysis or rapidly worsening neurological symptoms.
- Severe pain after significant trauma.
- Fever or serious illness together with significant new spinal or joint pain.
- Sudden severe chest pain, difficulty breathing, fainting or severe abdominal pain.
- New severe unexplained pain in somebody with significant cancer or immune-suppression history.
- Possible opioid overdose: inability to wake, very slow or stopped breathing, severe unresponsiveness or blue/gray lips or fingertips.
In the United States, call 911 for a suspected opioid overdose and administer naloxone if available. In other countries, contact the local emergency service.
If you are unsure whether a new symptom is urgent, contact an appropriate medical service rather than assuming it is part of your usual chronic pain.
What Should You Focus on Most in Your Nonopioid Pain Plan?
This 20-question educational self-assessment can help identify areas to discuss with your healthcare team.
It does not diagnose the cause of your pain, opioid use disorder or suitability for naltrexone.
Your Top Priorities
You selected a possible new or concerning symptom. Self-management should not replace assessment of new neurological, systemic or otherwise serious symptoms.
Your answers suggest that opioid use is an important part of the picture.
Do not abruptly stop long-term opioids. A clinician can assess physical dependence, possible opioid use disorder, tapering options and nonopioid pain treatment.
If naltrexone is considered, it should be understood as an opioid-recovery treatment rather than a painkiller.
If opioids are currently being used, ask your clinician whether naloxone should be available and make sure people around you know how to respond to a suspected overdose.
This quiz does not diagnose a medical condition or determine whether a medication or procedure is suitable for you. Use the results to prepare questions for a qualified clinician.
Managing Chronic Pain Without Opioids: FAQ
These answers provide general educational information. Chronic pain can have many causes, so diagnosis and treatment should be individualized.
1. Can chronic pain really be managed without opioids?
Often, yes. Nonopioid management may combine condition-specific medication, exercise, physical therapy, psychological therapies, sleep treatment and specialist care. The most appropriate combination depends on the diagnosis and patient.
2. Does “without opioids” mean opioids are never appropriate?
No. Opioids can be appropriate in selected medical situations. The decision should consider expected improvement in pain and function against the individual patient’s risks.
3. What counts as chronic pain?
Chronic pain is generally defined as pain persisting or recurring for longer than three months.
4. What nonopioid medicines are used for chronic pain?
Depending on the diagnosis, options can include NSAIDs, acetaminophen, selected antidepressants, selected anticonvulsants and topical medicines. Every class has its own potential benefits and risks.
5. Are NSAIDs automatically safe because they are not opioids?
No. NSAIDs can cause gastrointestinal, kidney and cardiovascular problems in some patients, particularly with prolonged use or certain medical conditions.
6. Why are antidepressants sometimes prescribed for pain?
Certain antidepressants influence nervous-system pathways involved in pain processing and have evidence for selected neuropathic pain and other chronic-pain conditions. Their use does not mean the pain is imaginary.
7. Do gabapentin and pregabalin work for every kind of pain?
No. They may be useful for selected neuropathic pain conditions, but benefit is condition-specific and they can also cause adverse effects such as sedation or dizziness.
8. Why exercise if movement causes pain?
Appropriate exercise can improve function in several chronic-pain conditions. The aim is not to force through severe symptoms but to begin at an appropriate baseline and progress gradually.
9. Can physical therapy help chronic pain?
Yes, for many conditions. Physical therapy can address strength, mobility, balance, graded activity, movement patterns and confidence.
10. Does CBT mean doctors think my pain is psychological?
No. CBT can help manage the real effects of pain, including fear, avoidance, stress, disrupted sleep and all-or-nothing activity patterns.
11. Can improving sleep affect chronic pain?
Pain and poor sleep can reinforce each other. Identifying insomnia, sleep apnea, medication effects or another sleep problem may therefore be an important part of pain management.
12. Should I stop taking opioids if I want nonopioid treatment?
Do not abruptly stop long-term opioid therapy without medical guidance. Physical dependence can occur even when opioids are taken as prescribed. When reduction is appropriate, it should normally be individualized.
13. Is physical dependence the same as opioid addiction?
No. Physical dependence means the body has adapted and withdrawal may occur after reduction. Opioid use disorder is a broader diagnosis involving a problematic pattern of opioid use causing significant impairment or distress.
14. What if chronic pain and opioid use disorder occur together?
Both problems deserve treatment. The patient still needs effective pain care while receiving evidence-based treatment for opioid use disorder.
15. Does standard naltrexone treat chronic pain?
Standard-dose naltrexone used for opioid or alcohol use disorder is not a conventional analgesic. In this context, its role is supporting addiction treatment, not treating the underlying source of chronic pain.
16. How can naltrexone become part of a chronic-pain plan?
If chronic pain coexists with opioid use disorder and an opioid-free recovery approach is selected, naltrexone may be used for the addiction-treatment component while pain is managed with nonopioid strategies.
17. Can I start naltrexone while taking opioid pain medication?
A physiologically opioid-dependent patient should not simply start naltrexone. It can precipitate severe withdrawal. Appropriate opioid-free preparation must be determined by the treating clinician.
18. What happens if I need surgery while long-acting naltrexone is active?
Tell the surgical and anesthesia team in advance whenever possible. Opioid analgesia may be blocked. Nonopioid and regional techniques may be considered, while emergency opioid use requires specialist monitoring.
19. Are naltrexone implants FDA-approved in the United States?
No. The FDA-approved long-acting naltrexone formulation for opioid use disorder in the United States is extended-release intramuscular naltrexone. Implant products have separate, product-specific regulatory status.
20. What is the most important first step?
Begin with a clear diagnosis and meaningful functional goals. Then build a multimodal treatment plan matching the condition, health risks and what you need to do in everyday life.
Understand Your Recovery Options Before Making a Treatment Decision
If chronic pain has become connected with opioid dependence or opioid use disorder, the answer should not be to ignore the pain or suddenly remove opioids.
Both problems need a safe treatment strategy.
DeBinge can explain the role of long-acting naltrexone, preparation requirements and recovery planning.
Naltrexone does not replace an individualized chronic-pain assessment and should not be presented as an analgesic.
Scientific References and Further Reading
This guide draws on U.S. clinical guidance, international chronic-pain definitions, systematic evidence reviews and official medication information.
CDC — Nonopioid Therapies for Pain Management
Current CDC clinical overview of nonpharmacologic and nonopioid medication options for acute, subacute and chronic pain.
Read CDC Guidance →CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Recommendations covering nonopioid therapy, opioid initiation, follow-up, risk mitigation and patient-centered tapering.
Read the CDC Guideline →International Association for the Study of Pain — Chronic Pain Definitions
Defines chronic pain as pain persisting or recurring for longer than three months and describes its multifactorial nature.
Read the IASP Definitions →AHRQ — Noninvasive Nonpharmacological Treatment for Chronic Pain
Systematic evidence review examining exercise, psychological therapies, multidisciplinary rehabilitation, mindfulness, acupuncture and other noninvasive treatments.
Read the AHRQ Review on NCBI →AHRQ — Nonopioid Pharmacologic Treatments for Chronic Pain
Comparative evidence review examining nonopioid medication benefits and harms across several chronic-pain conditions.
Read the AHRQ Medication Review →VA/DoD Clinical Practice Guideline — Opioids in Chronic Pain
Evidence-based guidance covering opioid appropriateness, initiation, maintenance, tapering, discontinuation and patient safety.
Read the VA/DoD Guideline →American College of Physicians — Chronic Low Back Pain
Clinical guideline recommending several nonpharmacologic treatments as initial options for chronic low back pain.
Read on PubMed →SAMHSA TIP 63 — Medications for Opioid Use Disorder
Federal clinical guidance covering methadone, buprenorphine, naltrexone and broader services supporting recovery from opioid use disorder.
Read SAMHSA TIP 63 on NCBI →SAMHSA TIP 63 — Chapter 3C: Naltrexone
Detailed federal guidance covering naltrexone, opioid-free preparation, pharmacology and clinical safety considerations.
Read the Naltrexone Chapter →FDA — Extended-Release Naltrexone Prescribing Information
Current prescribing information includes warnings concerning opioid blockade, precipitated withdrawal, reduced tolerance, overdose vulnerability and emergency pain management.
Read the FDA Prescribing Information →2025 Cochrane Review — Sustained-Release Naltrexone
Systematic review of sustained-release injectable and implantable naltrexone for opioid dependence.
Findings differ according to the comparator treatment and formulation, and the review identifies important remaining evidence limitations.
Read the Cochrane Review →Tame the Beast — Persistent Pain Education
Public chronic-pain education project developed with pain scientist Professor Lorimer Moseley and collaborators.
Explore Tame the Beast →Research on naltrexone for opioid use disorder should not be interpreted as evidence that standard-dose or sustained-release implant naltrexone treats the underlying cause of chronic pain.
Implant products may differ in dose, release profile, duration, manufacturing and regulatory status.
Clinical information about nonopioid alternatives for pain.
Explore CDC → SAMHSA TIP 63Federal guidance on medications for opioid use disorder.
Read TIP 63 → IASP High-Impact Chronic PainInformation about chronic pain that substantially limits function and participation.
Explore IASP → Dr Fergus LawClinical and scientific profile, addiction expertise and published research.
View Profile →Prepared for medical review by Dr. Fergus Law, BSc, MBChB, FRCPsych
Consultant Psychiatrist specialising in substance misuse and addiction psychiatry
Review status: Pending clinical approval
Medical evidence and clinical guidance can change. This article is educational and does not replace diagnosis, prescribing advice or an individualized treatment plan from a qualified healthcare professional.