Painkillers & Chronic Pain: When the Cure Becomes the Problem

This is the hardest situation in the whole opioid story, and the one that deserves the most care. If you live with chronic pain — real, daily, grinding pain — and suspect that the painkillers meant to help have become a problem of their own, you're in a genuine bind. You are not a stereotype chasing a high; you're someone who hurts, given a legitimate treatment that has turned into its own difficulty. This needs nuance, not judgement.

The bind: you need them, and they've turned on you

What makes chronic pain different from every other route into opioid trouble: you can't simply be told to stop, because the pain is real and still there. Caught between a body that hurts and a medication that's quietly stopped working cleanly, the guilt runs deep — am I in pain, or am I addicted, or both? Please hear me: needing the tablets and being dependent on them can both be true at once, and neither makes you a bad person.

When the painkiller starts making the pain worse

There's a cruel twist worth knowing. With long-term opioid use, some people develop opioid-induced hyperalgesia — the medication can actually make the body more sensitive to pain over time. So you take more to chase relief that never quite comes, the dose climbs, and you end up in more pain than when you started, not less. It's a recognised effect, not a personal failing.

The non-judgemental path: work with your doctor

This is not one to sort out alone or to white-knuckle. The right move is an honest conversation with your GP or pain team — not to take your relief away, but to manage both the pain and the dependence better. Good pain medicine has moved a long way from "more opioids," and there's a lot in the toolkit:

• A careful, gradual taper — never abrupt — that lowers the opioid slowly while keeping pain managed, often improving function rather than harming it.
• Other medications and treatments for pain that don't carry the same dependence risk.
• Physiotherapy, movement and pacing, which genuinely shift chronic pain for many people.
• Pain-management programmes and psychological approaches — chronic pain has a large emotional and nervous-system component, and treating that can reduce the pain itself.

Be honest with your doctor about how much you're taking and how you're really doing — they won't judge you, they see this constantly, and honesty is what lets them help. My roadmap on how to come off painkillers walks through how a taper works.

A safety note that matters even here

Two things I can't leave out, true even when the pain is real. First, coming off should be a gradual, GP-supervised taper, not a sudden stop — opioid withdrawal is rarely directly fatal, but stopping abruptly is miserable, unsafe, and no way to manage chronic pain. Second, and most important: tolerance falls once you reduce, so going back to a higher dose after a break — including after a spell in hospital or a few missed days — can cause a fatal overdose. This catches pain patients out, not just recreational users, so if your dose has dropped, never jump back to your old amount without medical advice. Naloxone, which reverses an opioid overdose, exists and can be supplied to families in many areas — well worth asking your doctor about. That same tolerance-drop trap kills people across other drugs too, which I cover in my guide to cocaine overdose.

You don't have to choose between being in pain and being free of the tablets. Done properly, with your doctor, the goal is both — less reliance and better-managed pain.

Where I fit in

Your doctor leads the medical and pain side — that's essential. I sit alongside it: the relationship with the medication, the fear of life without that buffer, and the way chronic pain and dependence feed each other. That's the psychological work — gentle, practical and without judgement — and understanding your triggers can genuinely ease the load. If you're unsure where the line sits for you, my self-check on whether you're addicted to painkillers is written with your situation in mind, and the wider picture is in my guide to painkiller and opioid addiction.

I came through my own addiction, so I know that fear — and with chronic pain it's even more tangled. But there is a kinder, safer way through that doesn't abandon you to the pain. You don't have to untangle it alone.

Gary Clinton

Ireland's addiction specialist — CBT-qualified therapist, bestselling author of Never Give Up, and an ex-addict himself. Private one-to-one help for professionals, online and worldwide.