It's not unusual to find that patients with substance-use disorders tend to have a lower tolerance for pain. This is due to the changes that the substance-use had on their brains when they were using their drug of choice. Drugs work on the brain by changing how the brain responds to stressors including pain and trauma. Some of these changes are permanent and others are on the edge of tipping the person back over the edge into substance-use again. 

To further complicate the situation, these patients often have co-occurring disorders such as emotional, physical, or mental disorders that are also a contributing factor to their situation. this can make it far more challenging to treat these patients. 

Substance-use disorders are a complicated and chronic disease. It's not unusual to find that these patients are struggling on a daily basis. So how then do doctors achieve pain management for these patients? Doctors are beginning to include substance abuse management as a part of the treatment protocol. They're including addiction treatment specialists in the care team and focusing on treating the patient as a whole instead of only treating the pain condition. 

It's also important to treat such patients with respect and not disdain. The patient, as a whole, is in pain due to their particular medical condition and it's not always possible to separate the two in one's mind. To make matters worse, the patient can't, in their own mind, discern the difference between needing the medication for pain, and the brain telling it that it requires the medication due to an addiction. 

However, it's vital to find a way for the patient to have the pain relieved. To do this, doctors are focusing on medications that are less addicting than opioids that were formerly used. Doctors are also using stress relief sessions as well as counseling with addiction specialists to help the patient learn to properly manage their particular pain. It's far too easy for a substance-use disorder patient to relapse during a stressful and painful medical condition than at any other time in their life. The patient has to literally want to remain clean and sober and this is no easy feat for anyone who has a substance-use disorder. 

Substance-use disorder patients are seeking relief from a particular situation, feeling, or something that is simply lacking in their life and they don't have the skills of coping like the rest of society does. Even with counseling and proper medical care, these patients struggle with these feelings frequently and in many cases, on a daily basis. 

It's important to also note that substance-use disorders know no bounds. These patients can come from a well-educated background as well as from a lower class of citizen that is far less educated. Doctors need to recognize this when treating anyone with pain medications. Young and old, rich and poor, these patients come from all walks of life. 

Some former substance-use disorder patients go the complete opposite end of the spectrum when it comes to treating their pain. In their quest to avoid becoming addicted again, they would rather live with the pain than using any type of medication to deal with their situation.

It's vital for nurses and doctors to respect this decision but to reassure the patient that the medication will be there should they ever decide to go that route. These patients are bound and determined to never again have a substance-use disorder and go to the opposite extremes to avoid it. 

The care team for pain management should always include a substance-use professional, dietician, mental health professional, as well as the doctors and nurses that make up the care team. Each team member can work closely with the patient to ensure that they're following the proper diet, getting the proper exercise, getting plenty of rest, taking their prescribed medications, over the counter remedy for pain, and staying on track with their appointments. 

When patients begin missing appointments, not eating a healthy diet, and losing sleep, the patient is at a far higher risk for relapsing back to substance-use disorders. Doctors will need to watch these patients a little bit more closely than other patients that they see. 

Taking note of mood changes, weight changes (gain or loss), changes in sleeping patterns (insomnia or sleeping more than usual), will all have to be noted and addressed in order to effectively treat such patients. These patients may require more frequent visits to their primary care doctor to help them avoid relapse. 

Another option for treating such patients is to have a designated medication dispensing person. This person can give them the proper dosage of their medication at the proper time. If they're having breakthrough pain this person can help to discuss the options with a doctor and the patient to ensure that the patient isn't going to go back down the road of substance abuse. 

It will require a highly trained professional who understands substance-use disorder to fully understand medication dispensing. It's far too easy to believe the patient regarding the need for more pain medication if they're not familiar with the situation. There are many times that a former substance-user will require serious pain medications. These include a cancer diagnosis, serious dental work, chronic pain conditions, injuries, and surgical procedures such as a knee replacement or a hip or shoulder replacement. 

Doctors should take every possible precaution to ensure that these patients are always treated with dignity and respect and they'll need to work closely with the patient and the care team to ensure a healthy outcome for the patient without any risk of relapse. 

In today's modern era, more doctors than ever before are in the know about such medical risks. However, there are still a few who aren't familiar with such conditions. Involving a well trained care team will go far in having a successful outcome and achieving proper pain management in patients who have a history of substance-use disorder. Patient's will have to be open and honest with an accountability partner and their care team for proper pain management.