Chronic pain and addiction recovery: a care guide for Veterans

Before your appointment

For a Veteran seeing several clinicians, a useful first step is asking who will connect the plans. That might begin with your VA primary care team or the clinician already treating your substance-use condition. The aim is a clear plan for pain, recovery, and the practical demands of daily life.

What does coordinated care look like?

In the Q&A of her 2017 lecture, Anna Lembke, MD, describes the value of a team in which clinicians, therapists, and case managers contribute different skills. That is the starting point for this guide's appointment questions. The lecture does not establish that every service will be available locally. Watch the team-care discussion around 1:12:34.

Ask the team to help you put the following in one place:

• The clinician responsible for each medication and whom to call with questions.
• Your pain and recovery goals, such as attending treatment, sleeping better, or returning to a valued activity.
• The referrals being considered and who will help arrange them.
• A plan for worsening pain, cravings, or difficulty following treatment.
• The next check-in date and a contact between visits.

Bring a medication list that includes prescriptions from VA and community clinicians. Ask how updates will be shared, especially after urgent care, dental treatment, or surgery. You can also ask what information will be shared and what consent is needed.

Does recovery require stopping all medication?

No. In opioid use disorder, medication is an evidence-based treatment. FDA-approved options include buprenorphine, methadone, and naltrexone. Detoxification by itself is not recommended treatment for OUD because of the risk of returning to use and overdose. A clinician should help choose the treatment and manage it safely. CDC treatment guidance.

Some OUD medications can also help with concurrent pain, but you still need an individualized pain assessment. Don't start, stop, or adjust a medicine because of an article or advice from a support group. Ask the prescriber how your recovery treatment and pain treatment fit together. CDC guidance on concurrent pain care.

If your substance-use history involves alcohol or another drug, the treatment decisions may be different. Tell your team what you are using or have stopped using, what treatment has helped, and what concerns you now.

What can help besides medication?

Ask which rehabilitation, behavioral, or other pain treatments are appropriate for your condition. The Veteran chronic pain care guide can help you prepare for that discussion. A useful question is: “How would this treatment help my specific daily goal, and how will we decide whether it is helping?”

Evidence for treatments aimed at chronic pain and OUD together is still developing. A September 2026 VA evidence summary found a small, varied set of trials, often with methodological limitations and short follow-up. Some approaches were promising, but the review does not support promising that one therapy will resolve both conditions. VA evidence summary on co-occurring chronic pain and OUD.

Ask about peer support if it interests you, and be specific about what you want: someone to talk with, help staying engaged in appointments, or a group that understands chronic pain. Peer support can accompany clinical care; it should not decide your medication plan.

How can a Veteran start this conversation?

You could say: “I'm working on recovery, and pain is making daily life difficult. Can we make a plan that addresses both?” If you have a VA primary care provider, ask about assessment and treatment. Without one, VA directs Veterans to a local VA medical center or substance use disorder program to find care. VA substance use treatment options.

Explain barriers before they become missed visits: transportation, childcare, work hours, cost questions, or difficulty using video appointments. Ask whether a social worker or care coordinator can help. Availability varies, so leave with an agreed next step rather than assuming a referral is already arranged.

For OUD, ask your clinician about naloxone and overdose-response education for you and people close to you. CDC recommendations for additional OUD care.

If you also want information about Valor's home-based chronic pain program, use the inquiry options below and discuss fit with your treating team. This program inquiry does not arrange addiction treatment, withdrawal management, or changes to recovery medication.

About this guide

Based on the complete available automatic captions and selected visuals from Anna Lembke's part 1 lecture, presented May 11, 2017 and published by Health Improvement Partnership SCC on June 22, 2017. The Veteran care-planning suggestions are editorial additions checked against CDC and VA sources. Part 2 was not reviewed. Educational guide; no clinical sign-off recorded.