Chronic pain and substance-related concerns call for a coordinated plan that continues to take pain seriously. In London, this may involve a GP, a pain service, a prescribing clinician, and an addiction team. The aim is to understand the pain, clarify any medication or substance-related problem, and agree how the professionals will work together.
Taking a prescribed pain medicine does not automatically mean someone has an addiction. Nor does identifying a substance use disorder mean that pain is no longer real or deserving of treatment. The Faculty of Pain Medicine’s guidance emphasizes communication, a broader pain management plan, and collaboration between pain, primary care, and addiction services.
Use precise language about the concern
Physical dependence, tolerance, and addiction describe different issues. Physical dependence can involve withdrawal symptoms when a medicine is reduced or stopped. Tolerance refers to changes in response with continued use. Addiction involves a problematic pattern of use that needs clinical assessment. These terms should not be used as interchangeable labels for anyone receiving long-term medication.
The MHRA’s opioid safety information explains the risks of dependence and addiction with opioid medicines. If a clinician raises a concern, ask what specifically they have identified. Is the question about adverse effects, limited benefit, withdrawal, taking medicine differently from the prescription, or a possible opioid use disorder? The answer affects what help is appropriate.
A medication review should also allow the patient to describe benefits. For example, explain whether a medicine helps with a particular activity and whether that benefit has changed. Include difficulties honestly. A useful discussion can acknowledge that a treatment has helped in one way while creating problems in another, without forcing an all-or-nothing account.
Clarify the pain diagnosis and what remains uncertain
Chronic pain is not a single condition. NICE guidance on chronic pain distinguishes chronic primary pain from chronic secondary pain and covers assessment across both. Its management recommendations for chronic primary pain should not be applied indiscriminately to every painful condition. Cancer-related pain, a new injury, and an established long-term pain condition can require different clinical pathways.
Ask the pain clinician what diagnosis or working explanation is being used and which questions remain unresolved. Bring previous investigations and specialist letters if available. A new professional should understand what has already been assessed before proposing another investigation or assuming that the only remaining issue is medication use.
Describe function as well as intensity. What happens when you sit, walk, travel, sleep, work, or care for someone? Which activities matter most to you? These details help make treatment goals concrete. They should complement clinical assessment, not become a test of whether the pain is sufficiently visible or disruptive to be believed.
A medication review should cover the whole picture
Prepare one list of prescribed medicines, nonprescription products, alcohol, and other substances. Include what you actually take, not just the wording on an old prescription. Mention medicines obtained from more than one service and any recent changes. The purpose is to help the clinician identify relevant interactions, duplication, withdrawal concerns, and monitoring needs.
Explain what happens on a difficult pain day. Do you run out earlier than expected, delay a dose because of a side effect, or use something else when an appointment is unavailable? Different situations need different responses. A clinician cannot develop a workable plan from a medication list alone if the daily pattern is missing.
Do not abruptly stop dependence-forming medicines because a provider describes them as undesirable. NICE guidance on medicines associated with dependence or withdrawal symptoms supports individualized decisions and planning. Any proposed reduction should include a responsible prescriber, a way to review difficulties, and continued attention to the condition for which the medicine was originally used.
The prescription medication guide explains these distinctions further. A short rehab stay does not determine how long a person’s medication plan should take. Ask how care will continue if the agreed clinical process extends beyond the booked program.
What pain rehabilitation can contribute
A pain management program is not simply a course in ignoring symptoms. Ask what the particular program offers and how its goals relate to your life. It may involve professionals with different skills, but their roles should be explained. A psychological component does not mean the service believes the pain is invented.
The UCLH multidisciplinary pain service describes support from physiotherapy, psychology, and nursing. Its published pathway includes an information session and assessment, followed by discussion of suitable group or individual options. It focuses on personally meaningful goals and skills for living with persistent pain. It does not promise that every referred patient will receive the same intervention.
For someone with substance-related concerns, ask how the pain team will communicate with the relevant prescriber or addiction service. The existence of a multidisciplinary pain program does not automatically make it a drug treatment program. Each service’s contribution should be confirmed so that the patient is not left to reconcile separate recommendations alone.
Understand the London referral route
A GP or current specialist can help identify the appropriate pain pathway and provide the clinical background for referral. The UCLH Pain Management Centre is one London example, with different services for different circumstances. Ask which service is being requested and what question the referral is intended to answer.
Do not confuse a hospital’s inpatient pain team with an elective residential program. UCLH’s Inpatient Complex Pain Team states that it does not accept outpatient referrals. A patient seeking planned outpatient support should use the relevant outpatient route rather than assuming that an inpatient team offers a bookable rehab admission.
Location also affects the practical plan. A central London appointment may require a long journey from an outer borough, particularly if pain limits travel. Ask whether the assessment or some follow-up can occur remotely, what requires attendance, and how to arrange any needed accessibility support. Confirm the actual service’s options rather than relying on a general hospital website.
When an addiction service is also needed
If a substance use disorder is suspected or diagnosed, an addiction service can assess the relevant treatment needs. The NHS guide to drug treatment describes access through a GP or local service. Share the pain history and prescribing information at the start so the team understands the wider situation.
For opioid use disorder, treatment decisions are distinct from a routine review of a pain prescription. If opioid agonist treatment is being considered or already used, pain and addiction clinicians need to agree their responsibilities. The opioid agonist treatment guide discusses the care pathway; it does not provide a dosing plan.
Ask what each team will do if pain becomes harder to manage. A substance-related diagnosis should not result in every new symptom being attributed to addiction. Equally, the existence of pain should not prevent assessment of a harmful pattern of use. A shared plan allows both concerns to be addressed without forcing the patient to choose one account.
Agree a practical response to difficult days
A written plan for a pain flare can reduce uncertainty. Ask the treating clinician what changes warrant medical review, what agreed self-management approaches are suitable, and whom to contact if the usual plan is insufficient. Do not create your own medication escalation schedule from internet advice. The plan needs to fit the diagnosis and current prescriptions.
Consider the circumstances in which unplanned use occurs. It might follow a canceled appointment, an unusually demanding workday, isolation, or fear about a symptom. Describing the situation is useful even when you are unsure how to change it. The team can help decide whether the missing support is clinical, practical, psychological, or a combination.
Family members can assist with agreed tasks without taking control of treatment decisions. For example, they might help keep track of appointments or join a discussion about household demands. Ask what information the patient wants shared and who should be contacted if there is an urgent concern. The family’s role should be clear and manageable.
Compare residential programs against the actual needs
If considering rehab, ask how the program accommodates pain-related mobility, sleep, seating, and activity needs. A standard exercise timetable may require adaptation. Establish who reviews medication, whether a pain specialist is involved, and where additional assessment occurs. An advertised wellness component is not the same as a defined pain treatment pathway.
The accessible rehab guide helps evaluate practical arrangements, while the medication review guide addresses preparation for clinical discussions. If the residential site is outside London, ask how local follow-up will work after returning. A London admissions office does not answer that question.
Continue care after a medication or program change
Before discharge or transfer, confirm the next prescriber, pain follow-up, and any addiction appointments. Ask who holds the current medication list and how updates will reach the GP. Include plans for weekends, missed appointments, and changes in symptoms. These details are especially important when several organizations have been involved in the same episode of care.
A helpful plan recognizes pain, explains the substance-related concern accurately, and identifies the next practical step. If there is a suspected overdose, severe breathing difficulty, or another immediate emergency, call 999. For urgent concerns that are not an emergency, seek medical advice through the treating team, a GP, or NHS 111 rather than waiting for a routine review.