5 Opioid Use Disorder-Related Conditions: Chronic Pain, PTSD, and More

Living with opioid use disorder (OUD) can be complicated. It’s not just the cravings and withdrawal symptoms — the challenges often extend far beyond the disorder itself. Other health problems, both mental and physical, commonly appear before, after, or alongside it. You may hear these referred to as comorbid conditions or co-occurring conditions.

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Conditions related to OUD can affect everything from your mood and sleep to pain and organ health, like your liver. In this article, we’ll cover five conditions that are most commonly related to OUD, including chronic pain, post-traumatic stress disorder (PTSD), and others. We’ll also explain why they might happen and how treating them alongside OUD can support overall recovery.

What Is Opioid Use Disorder?

Opioids are narcotics that treat moderate to severe pain. They attach to opioid receptors in the brain and other parts of the body, which lowers pain signals. Opioids also affect brain cells that normally block dopamine, a brain chemical that creates feelings of pleasure or a “high.” As a result, more dopamine is released, which can make opioids addictive. Prescription opioids include pain medications like oxycodone, hydrocodone, and morphine. Opioids also include illegal drugs, such as heroin.

OUD is more than just “using too much.” It’s a real and complex medical condition that can lead to debilitating symptoms in the body and mind. It can also cause problems at home and work. In the United States, OUD is recognized as a major public health crisis.

OUD rarely happens on its own. It’s often connected to other health problems, which may be caused by OUD, contribute to it, or make it harder to manage. Here are five of the most common related health problems.

1. Chronic Pain

Chronic pain is one of the most common conditions linked to OUD. Chronic means “long term,” so chronic pain is pain that lasts for months or even years. It can be caused by injuries, arthritis, nerve damage, or other long-term health issues. This condition is very common. According to the Centers for Disease Control and Prevention (CDC), more than 20 percent of adults in the U.S. — over 50 million people — reported having chronic pain in 2021. As reported in an article in The Journal of Pain, chronic pain affects about one-quarter to two-thirds of people living with OUD.

For some people, chronic pain comes first, and then opioids are prescribed to help manage it. Over time, though, regular use of opioids changes the way the body processes pain. This can lead to opioid-induced hyperalgesia — a condition where pain signals become stronger, making even mild discomfort feel painful.

Chronic pain and OUD can feed into each other. Living with constant pain can increase stress, lower mood, and raise the risk of opioid misuse. At the same time, opioid dependence can make it harder to manage pain without medication.

Treating chronic pain alongside OUD often includes non-opioid pain management strategies, such as:

• Physical therapy, massage, or exercise
• Rest, ice, or heat
• Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen (Tylenol)
• Lidocaine patches

Your healthcare team may also recommend certain medications for OUD, such as methadone or buprenorphine. These help reduce cravings while also controlling pain.

2. Post-Traumatic Stress Disorder

PTSD can develop after living through or witnessing one or more traumatic events. For example, these include military combat, physical or sexual assault, serious accidents, or natural disasters. People with PTSD may have flashbacks, nightmares, or trouble sleeping or feel constantly on guard. One study found that 41 percent of people with OUD have experienced PTSD at some point in their lives. About 33 percent meet the criteria for a current PTSD diagnosis.

Trauma can be a risk factor for developing OUD. Some people may misuse opioids as a way to numb painful memories or curb anxiety as a form of self-medication. However, over time, opioids can make PTSD symptoms harder to manage. When OUD and PTSD occur together, the effects can be more severe. Studies show that this combination is linked to higher rates of depression, more intense opioid use, and an increased risk of attempting suicide.

Treatments work best when both conditions are addressed at the same time. This may include evidence-based therapies — like cognitive behavioral therapy (CBT) or exposure therapy. CBT helps people change unhelpful thought patterns, while exposure therapy gradually helps them face memories or situations linked to the trauma in a safe, controlled way. OUD medications, including naltrexone, may also be given. Primary care and mental health providers often work together in these cases.

3. Depression and Anxiety Disorders

Mental health conditions, like depression and anxiety, commonly occur alongside OUD. According to one large review, about 36 percent of people with OUD also have depression, and around 29 percent experience anxiety.

When depression or anxiety occurs at the same time as OUD, recovery can be even harder. Depression may deepen feelings of hopelessness, while anxiety can increase stress and restlessness. These conditions can raise the risk of opioid misuse, increase cravings, and increase the risk of opioid overdose. They may also get in the way of sticking with opioid treatment or finding joy in everyday life.

A combined approach is often recommended. For example, this might include medications, counseling, talk therapy, or support groups. Buprenorphine is currently being studied for its use in treating both OUD and depression.

4. Hepatitis C

Hepatitis C is a viral infection that can damage the liver. It spreads most often through blood-to-blood contact, such as sharing needles. This means that people with OUD who inject drugs are at the highest risk. Taking opioids in pill form can’t expose you to the hepatitis C virus. However, someone who transitions from taking pills to injections can be exposed.

Hepatitis C can cause serious health problems over time, including liver failure and liver cancer. In some cases, though, it can take years for symptoms to appear, so regular testing is important. Possible signs include:

• Fatigue (extreme tiredness that doesn’t go away with rest)
• Loss of appetite or weight loss
• Jaundice (yellowing of the skin or whites of the eyes)
• Dark urine or pale stools
• Bruising or bleeding easily
• Muscle aches
• Trouble thinking clearly or slurred speech

Hepatitis C can be treated with a 12-week course of antiviral medication. Treating it not only improves liver health but may also help with overall well-being during OUD recovery.

5. Alcohol Use Disorder and Other Substance Use Disorders

OUD is a type of substance use disorder (SUD). However, it’s very common for people with OUD to also have other SUDs. One recent study found that about 60 percent of people with OUD had at least one other current SUD. Most often, this involved cocaine, alcohol, cannabis, sedatives, or methamphetamine. About 27 percent of people with OUD met the criteria for alcohol use disorder (more than 1 in 4 people).

Having OUD with another type of substance use can make recovery more challenging. It raises the risk of overdose, makes cravings harder to control, and complicates treatment. That’s why doctors often recommend integrated care — treating all substance use as part of the treatment plan. Depending on which substances someone is using, they may need to start with medically assisted detoxification. This technique uses medical supervision and, when needed, medications to help clear drugs from the body safely and reduce withdrawal symptoms.

Detoxification alone isn’t a cure, but it can be the first step in a comprehensive treatment plan. After medically supervised detoxification, ongoing care may include medications for OUD, therapy, support groups, and regular follow-up with a psychiatrist (mental health specialist) trained in opioid addiction.

These five conditions are just some of the health problems linked to OUD. If you or a loved one is living with OUD and notices symptoms of another condition, talk to a healthcare provider. The right treatment can address both OUD and related health issues.

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On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

Do you have any health conditions related to opioid use disorder? Let others know in the comments below.