Living with pain day after day is exhausting. Chronic pain can steal sleep, concentration, work, relationships, and joy. When pain does not ease, it is completely understandable to want fast relief—something that makes the discomfort stop, even briefly.
For many people, that relief comes in the form of opioid pain medications such as oxycodone, hydrocodone, or morphine. These medications are often prescribed with good intentions, and in the short term, they can help. But when pain becomes long-lasting, opioids can quietly introduce changes in the brain and nervous system that complicate recovery rather than restore it.
Understanding how chronic pain works, how opioids affect the brain’s pain-control systems, and what safer, more effective long-term approaches look like can be a critical turning point.
What Is Chronic Pain?
Chronic pain is pain that lasts for months or even years—often long after an injury, surgery, or illness should have healed. Unlike acute pain, which signals immediate injury or danger, chronic pain becomes a condition of its own.
In many chronic pain conditions—especially those known as centrally amplified or nociplastic pain (such as fibromyalgia or irritable bowel syndrome)—the issue is not ongoing tissue damage. Instead, the nervous system itself has become overly sensitive. The brain’s “volume knob” for pain is turned up, and its ability to turn pain down is impaired.
Research shows that in these conditions, the brain’s descending pain-inhibition systems—the pathways that normally send calming signals from the brain down the spinal cord to dampen pain—do not function as effectively. Pain signals are amplified, linger longer, and spread more easily.
Chronic pain rarely exists in isolation. It often travels alongside:
- Sleep problems
- Anxiety or depression
- Past trauma or chronic stress
- Social isolation and loss of routine
Each of these factors further sensitizes the nervous system, reinforcing a cycle where pain feels louder, more threatening, and harder to escape. For individuals facing both chronic pain and mental health challenges, integrated dual diagnosis treatment can provide comprehensive support that addresses these interconnected issues simultaneously.
How Opioids Can Help — and How They Can Quietly Work Against Recovery
Opioids can be effective for short-term, severe pain, such as after surgery or a major injury. In some carefully selected cases, they may play a limited role in chronic pain care. However, in centrally amplified pain conditions, opioids often fail to address the underlying problem—and may unintentionally worsen it over time.
Beyond tolerance or dependence, long-term opioid use can decondition the brain’s own pain-regulation systems. The brain normally produces its own opioid-like chemicals—endorphins and enkephalins—that help suppress pain and create resilience. When external opioids are supplied regularly, the brain may reduce its reliance on these internal systems. Physical symptoms like muscle aches and excessive sweating often accompany these changes, signaling the body’s struggle to adapt.
Over time, this can weaken communication between key brain regions involved in pain modulation—such as the periaqueductal gray and other brainstem hubs—and the spinal cord. In practical terms, the brain becomes less skilled at filtering pain signals on its own.
This creates a subtle but important problem: opioids may provide short-term relief while training the nervous system to rely on external numbing rather than internal regulation. Pain may feel better temporarily, but the brain’s natural “pain brakes” become less effective, making pain more widespread, persistent, and harder to treat in the long run.
This is why major clinical guidelines consistently recommend non-opioid strategies as first-line treatments for nociplastic pain conditions.
Why Many People Feel Better at First — Then Worse Later
One of the most challenging aspects of opioids is that they can create the impression of healing without actually restoring function.
By dulling discomfort, opioids can reduce the motivation—or perceived ability—to engage in movement, mindfulness, emotional processing, and gradual exposure to activity. Over time, this can lead to physical deconditioning, increased fear of pain, and a nervous system that becomes even more reactive.
In contrast, approaches like mindful movement, exercise, and meditation gently stretch the nervous system into tolerable discomfort, teaching the brain that pain does not automatically equal danger. These experiences strengthen the brain’s ability to separate pain from suffering and to suppress pain signals more effectively.
In other words:
- Opioids often soften and quiet the system.
- Mindfulness and movement train it.
Pain Is Not the Same as Suffering
There are many examples of people exposed to intense physical discomfort who do not experience the same degree of suffering: mixed martial artists, cold-water swimmers, breath-hold divers, endurance athletes. These individuals experience pain—but their brains interpret it differently.
They have learned, through repeated exposure, that pain can be intense yet safe, temporary, and even meaningful. This distinction—”this hurts” versus “this is dangerous”—is central to recovery from chronic pain.
Mindfulness-based practices help retrain this distinction. Pain may still arise, but it no longer dominates attention, identity, or fear.
Mindfulness-Oriented Recovery Enhancement (MORE): Retraining the Brain
Mindfulness-Oriented Recovery Enhancement (MORE) is an evidence-based program designed specifically for people living with chronic pain who use opioids. It combines:
- Mindfulness practices
- Cognitive-behavioral therapy (CBT) skills
- Positive psychology techniques
Clinical studies show that MORE can:
- Reduce pain intensity and pain interference
- Decrease opioid cravings
- Improve mood and quality of life
- Strengthen natural reward and pain-regulation pathways in the brain
Rather than suppressing pain signals, MORE helps rebuild the brain’s capacity to regulate them.
Other Tools That Support the Brain’s Natural Pain Control
A comprehensive approach may also include evidence-based therapies available through programs like our Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP):
Low-Dose Naltrexone (LDN)
In some centrally amplified pain conditions, clinicians use low-dose naltrexone to gently stimulate the brain’s endogenous opioid system, increasing the release of endorphins and improving pain modulation—essentially encouraging the brain to do more of the work itself.
Cognitive-Behavioral Therapy (CBT)
CBT helps challenge beliefs like “I’m broken” or “Any pain means harm,” reducing fear-based amplification of symptoms. CBT is also a cornerstone of effective dual diagnosis treatment for individuals managing co-occurring conditions.
Gentle Movement and Physical Therapy
Gradual exposure to activity rebuilds confidence, strength, and nervous-system tolerance.
Positive Psychology Practices
Savoring positive experiences helps restore reward circuitry that chronic pain often suppresses.
A More Complete Path Forward
At Heartfelt Recovery Centers, chronic pain and opioid use are approached together—not as separate problems. Treatment focuses on rebuilding the nervous system’s resilience, not just masking symptoms.
For some people, that means learning to live better with chronic pain. For others, it includes slowly and safely reducing opioids while strengthening internal coping systems. Understanding what it means to experience opioid withdrawal—sometimes called “dope sick”—is an important part of this journey, and our team provides compassionate support throughout the process.
Recovery is not a solitary journey. Our family therapy programs help rebuild relationships and provide support systems that are essential for long-term healing. Whether you’re supporting a partner in recovery or navigating your own journey, building healthy boundaries and communication patterns strengthens the foundation for sustainable change.
Recovery is a process, not perfection. If setbacks occur, knowing how to communicate openly about relapse can make the difference between isolation and reconnection with support.
If pain and medication are starting to feel intertwined, you are not failing—and you are not alone. There is a path forward that prioritizes safety, dignity, and real healing.
Need Support?
If chronic pain and opioid use are starting to feel intertwined, reach out to Heartfelt Recovery Centers. Our team is here to help you find relief, stability, and a path forward that prioritizes both safety and quality of life.
MD Mitchell Grant Cohen
Dr. Mitchell G. Cohen is a board-certified Internal Medicine specialist with over 34 years of experience in patient-centered healthcare. A graduate of Hahnemann University School of Medicine, Dr. Cohen completed his internship at the University Health Center of Pittsburgh, where he gained invaluable hands-on experience. He is also a certified addiction specialist, holding membership with the American Society of Addiction Medicine (ASAM).
Currently based in Nashua, NH, Dr. Cohen is affiliated with Saint Joseph Hospital, where he provides comprehensive care focusing on both internal medicine and addiction treatment. His expertise includes prevention, diagnosis, and management of adult diseases, as well as specialized care for individuals facing substance use disorders.
Dr. Cohen is committed to fostering open communication, ensuring his patients are fully informed and empowered to make confident decisions about their health and treatment options.
