The connection between chronic pain and opioids

In 2023, 24.3% of adults in the U.S. (more than 60 million people) experienced chronic pain—the term for persistent pain in any part of the body.

While chronic pain might be common, it can also be very disruptive to nearly every aspect of a person’s life. Understandably, people who deal with these ongoing aches or major discomforts are eager to find ways to keep their pain under control.https://carrumhealth.com/blog/industries-with-most-msk-pain/pain

From physical therapy or massages to injections or even surgery, there are various treatment options for chronic pain. Another treatment that’s commonly used? Opioids.

We’ll dive into the relationship between chronic pain and opioids in a bit, but let’s first review some more specifics about these two topics individually.

What is chronic pain?

Let’s start with an understanding of exactly what chronic pain is.

Chronic pain can range from mild discomfort, such as achiness and stiffness, to severe pain and agony that occurs in any part of the body. Pain is considered chronic if it lasts longer than three months, although the pain might come and go and may not maintain the same severity.

Chronic pain is a blanket term rather than a specific diagnosis, and there’s a lot of nuance in why and where it occurs. A variety of factors, such as injury, illness, or an ongoing medical issue like cancer or arthritis, can cause chronic pain. However, some people experience it without any clear explanation as to why.

Additionally, as mentioned, chronic pain can happen anywhere in the body. According to the Cleveland Clinic, common types of chronic pain include:

• Back pain
• Cancer pain (pain related to treatments or the cancer itself)
• Headaches (including migraines)
• Fibromyalgia
• Joint pain
• Neck pain
• Nerve pain (when damaged nerves send pain signals to the brain)

While pain needs to persist for longer than three months to be chronic, some people experience pain for many months or even years, and this can significantly interfere with their daily lives.

In a study from the CDC, 8.5% of adults (that’s more than 22 million people) had chronic pain that frequently limited their normal life or work activities.

What are opioids, and how do they work?

“Opioid” isn’t the name of one specific drug—it’s a class of drugs that includes both prescription medications and illegal drugs (like heroin). You might also hear opioids called things like “painkillers” or “narcotics.” Opioids certainly have their risks, but they can be effective for pain management.

Generally, opioids are split into three different categories:

• Natural opioids: Also called “opiates,” these are extracted directly from the opium poppy plant.
  • Examples: Morphine, codeine, opium, and thebaine
• Semi-synthetic opioids: These are made by chemically processing natural opioids.
  • Examples: Heroin, oxycodone, hydrocodone, and oxymorphone
• Synthetic opioids: These are completely manufactured and don’t contain any natural ingredients.
  • Examples: Fentanyl and methadone

There’s quite a bit of complex science behind how opioids work in the body. But, here’s the simple explanation: Opioids bind to specific receptors in the brain and spinal cord to block pain signals and minimize how the brain perceives pain. They also trigger the release of dopamine, which can create a sense of relief or euphoria.

Understanding the overlap between chronic pain and opioid use

Opioids have long been used to treat pain associated with cancer. But in the late 1990s, they started to be prescribed for other types of chronic pain.

Since then, they’ve become a fairly common treatment option. According to a 2019 report from the CDC, 22.1% of adults with chronic pain said they had used a prescription opioid in the past three months.

That’s for good reason: Opioids can be very effective, especially for treating certain types of pain. In one study, opioids led to a 30% reduction in patients’ chronic pain. However, their efficacy in managing long-term pain still isn’t well understood—and long-term opiate use also comes with significant risks.

The pros and cons of opioid use

Given the ongoing opioid epidemic, it’s understandable that opioids get a bad rap. However, these drugs aren’t entirely bad. When used appropriately and under adequate medical supervision, they can be beneficial for conditions like acute pain and palliative care.

But, much like with any other medical treatment, there are pros and cons to be aware of.

Pros

• Effective for managing severe and acute pain in the short term, such as pain from a surgery or injury
• Pain reduction can significantly improve patients’ quality of life and ability to handle activities of daily living
• Reduces the mental and emotional distress associated with extreme pain, which further improves pain levels and function

Cons

• Limited evidence for long-term effectiveness in treating chronic pain
• Negative side effects like sedation, nausea, vomiting, constipation, and slowed breathing that reduces the oxygen circulating in the body
• Long-term use can lead to organ damage, hormone disruptions, a weakened immune system, and risk of cardiovascular problems
• High risk of dependence and addiction, due to the release of dopamine and the “feel good” effect of opioids
• Patients can build a tolerance to opioids over time, meaning they need to increase their doses, which also increases their risk of negative side effects

How opioid use became a public health crisis

In 2017, the U.S. government declared opioid use a public health emergency. Since then, many doctors and medical professionals have been working to reduce opioid prescriptions.

But, how did we get here? In the late 1990s, opioids held a lot of promise as a safe and effective option for managing pain. Because of that (and the fact that opioids could be a major revenue generator), pharmaceutical companies marketed them aggressively, which led to a sharp increase in prescriptions.

The U.S. came to rely on opioids for pain management far more heavily than other economically advanced countries. And, by 2010, the amount of opioids prescribed peaked—fueling widespread misuse, addiction, and overdose.

Although prescriptions have been declining since 2010, opioid prescriptions still remain roughly three times higher than they were in 1999, making addiction and overdose an ongoing problem. There were an estimated 81,806 opioid overdose deaths in 2022 alone, and 90% of those deaths involved synthetic opioids other than methadone.

While it might seem grim, there is some positive news: In 2025, the CDC reported an almost 24% decline in drug overdose deaths in the US. That decrease can be attributed to a variety of factors, including more awareness and education for patients and providers, better access to treatment for substance use disorders, and widespread distribution of naloxone (a medication that reverses opioid overdoses).

The opioid epidemic has been one of the most significant public health crises the U.S. has dealt with, but there are some encouraging signs of progress. Prescription rates are declining, overdose deaths are trending downward, and both patients and providers are better informed about the risks of long-term opioid use.

But we’re not entirely out of the woods. Chronic pain remains widespread, and access to safe, effective, and sustainable treatment is still a major challenge.

Carrum Health is committed to supporting patients on their journey to relief. By connecting people with high-quality, evidence-based care from top providers (including treatment for substance use), we provide patients with what they deserve: Effective care that doesn’t come at the cost of their long-term health.

Learn more about how to partner with Carrum Health here.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.