A newly published Perspective in the New England Journal of Medicine argues that unaddressed pain is undermining patients’ ability to engage with treatment for opioid use disorder — and that the barriers to assessing and treating that pain remain stubbornly in place.
The Core Argument
The research, published in the New England Journal of Medicine, puts a sharp focus on something that often gets overlooked in addiction treatment: pain itself. The authors argue that pain interferes with daily activities and, critically, with a patient’s capacity to engage meaningfully with treatment for opioid use disorder (OUD). That’s a significant tension — the very condition that may have contributed to opioid use in the first place is also getting in the way of recovery.
Pain is, in plain terms, the body’s alarm system. Chronic pain — pain lasting more than three months — affects an estimated 28 million adults in the UK, according to NHS data, and is one of the most common reasons people are prescribed opioid-based medicines. For those who develop opioid use disorder, the relationship between pain and drug use becomes deeply entangled.
Why Treatment Gets Complicated
The Perspective’s authors contend that barriers to both the assessment and treatment of pain persist across healthcare settings. Yet those barriers aren’t always visible from the outside. Patients seeking help for OUD may have their pain dismissed, undertreated, or simply not assessed at all — partly because clinicians can find it difficult to separate the physical experience of pain from the behavioural patterns associated with addiction.
This matters because undertreated pain can drive patients back towards opioid use. It’s a cycle that standard OUD treatment frameworks don’t always account for.
The Wider Picture on Opioid Use
Opioid-related harm has been rising across England. NHS figures show that opioid prescribing, while declining slightly remains high — and drug-related deaths involving opioids continue to account for a major share of England’s overall drug mortality data. In Kent and Medway, as across much of the South East, local integrated care boards have been working to address both prescribing patterns and access to addiction treatment services, though demand consistently outpaces capacity.
The NEJM Perspective doesn’t offer a single solution. But it does call for pain to be treated as a legitimate clinical concern within OUD care — not a complicating factor to be set aside.
What Clinicians Are Being Asked to Consider
According to the authors’ position as summarised in the journal, the case is for better integration of pain assessment into OUD treatment pathways. That means trained clinicians asking about pain routinely, using validated tools, and offering appropriate management — whether that’s physical therapy, non-opioid analgesia, or psychological support.
It’s a straightforward ask on paper. In practice, stretched NHS services face real pressure to deliver it.
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Source: @NEJM
Key Takeaways
- Authors of a new NEJM Perspective argue that pain directly interferes with patients’ ability to engage with opioid use disorder treatment
- Barriers to pain assessment and treatment within OUD care pathways remain a persistent clinical problem, according to the research
- The Perspective calls for pain to be recognised and managed as a legitimate part of OUD treatment, not treated as separate or secondary
What This Means for Kent Residents
Patients in Kent who are receiving treatment for opioid use disorder — or who are supporting someone who is — should be aware that raising concerns about pain with a GP or treatment keyworker is both appropriate and clinically relevant. NHS Kent and Medway’s integrated care services include addiction treatment pathways, and patients have the right to ask for a pain assessment as part of their care plan. If you or someone you know needs support with opioid use disorder, contact your GP in the first instance, call NHS 111 for non-emergency guidance, or reach the Samaritans at any time on 116 123 — available 24 hours a day, seven days a week.