Deconstructing Medical Bias in Chronic Pain and Substance Use

Chronic pain is a way of life for millions of Americans. A 2024 CDC report puts the figure at 24.3%, showing how widespread persistent pain has become. Living with persistent pain can make everyday activities exhausting, leading people to seek different ways to manage their symptoms. 

People naturally develop coping mechanisms to get through ordinary routines. Unfortunately, dependency on the very medication meant to ease the pain is a real risk.

SAMHSA’s 2024 survey found that 70.1% of people misusing prescription pain relievers did so primarily to relieve physical pain. Although misuse doesn’t automatically indicate addiction, a history of substance use can influence how healthcare providers assess pain complaints. 

Sometimes, these assumptions arise unintentionally. Other times, concerns about medication misuse can overshadow genuine medical needs. This article explores how medical bias develops, how it affects chronic pain treatment, and what more balanced care could look like.

Added Scrutiny Around Pain Treatment

It’s not unusual for patients with a history of substance use disorder to face additional scrutiny when seeking treatment for chronic pain. Requests for stronger medication or complaints about persistent discomfort may raise concerns about misuse, even when the symptoms are legitimate.

A 2025 U.S. study involving 18 people recovering from opioid use disorder found that participants felt their pain complaints weren’t taken seriously. Some recalled being labeled “drug-seeking,” while others described receiving inadequate pain treatment. Such experiences can discourage patients from seeking medical attention when they need it.

Part of the difficulty comes from the way pain is assessed. Unlike blood pressure or blood sugar, pain cannot always be measured through objective tests. Doctors depend heavily on what patients report, alongside physical examinations and medical histories. 

When diagnostic findings are inconclusive, previous substance use can unintentionally influence how seriously those complaints are taken.

Of course, monitoring medication use remains an important part of responsible pain management. Urine drug screening is one method clinicians use to check for prescribed medications and identify other substances that could affect treatment safety.

Drug test cups are commonly used for preliminary screening because they allow healthcare providers to collect samples and check for multiple substances. When used correctly, these cups support accurate screening within routine clinical workflows, notes DrugTestsInBulk.

The best drug test cup for a clinic depends on its caseload, the substances being checked, and staff training. All of them must meet federal standards for point-of-care accuracy.

However, screening results alone cannot establish medication misuse or determine whether a patient’s pain is genuine. Unexpected findings may require confirmatory laboratory testing, while medical history and other clinical evidence provide the necessary context.

Used appropriately, these tools can support safer treatment decisions without allowing previous substance use to overshadow a patient’s current medical needs.

Why These Assumptions Still Persist

The roots of medical bias in chronic pain treatment go back several decades. The opioid crisis brought much-needed attention to the risks of prescription painkillers, including dependence, misuse, and overdose. 

Understandably, healthcare providers became more cautious about prescribing these medications, particularly to patients with a history of substance use.

However, caution can sometimes turn into suspicion when doctors have limited time to assess a patient’s condition. Incomplete medical records, inconsistent screening procedures, and previous treatment experiences can further influence their judgment. 

Under such circumstances, clinicians may rely on information already documented about a patient without fully exploring their present symptoms.

Even the language used in medical records can contribute to this problem. Terms like “drug-seeking” can follow patients across appointments, influencing how future clinicians approach their care.

A 2024 study by JMIR Formative Research found stigmatizing language in 29% of 221 hospital encounters involving opioid-related diagnoses. Most instances involved the term “abuse” when describing substance use.

The concern is that such language can influence future clinical assessments, even when the original doctor had no intention of treating the patient unfairly. Over time, these assumptions can become part of routine medical decisions, making it harder for patients to receive care based on their current symptoms.

How Medical Bias Changes Treatment Decisions

Medical bias can influence treatment in ways that aren’t immediately obvious to patients. A doctor concerned about medication misuse might hesitate to prescribe pain relief, recommend further tests, or refer someone to a specialist. 

Even follow-up appointments can become focused on medication use, leaving less time to investigate the underlying cause of pain. The concern becomes more serious when symptoms are repeatedly attributed to a patient’s substance use history. 

New pain, worsening discomfort, or unusual symptoms might be interpreted as signs of withdrawal or medication-seeking behavior. As a result, other medical conditions can go undiagnosed or receive attention much later.

While discussing clinician bias in sickle cell disease, Austin Wesevich, MD, MPH, MS, and a health services researcher at the University of Chicago Medicine, explained, “Clinicians cannot measure pain directly without asking the patient, so it’s a choice to believe patients when they share their pain levels.”

Bias can also work in the opposite direction. When treatment focuses entirely on relieving physical pain, early signs of substance use disorder can go unnoticed. Patients might continue receiving medication without adequate assessment of their dependence risks or access to addiction treatment.

The situation becomes particularly difficult when pain management and addiction services operate separately. Patients may receive conflicting advice, repeated assessments, or referrals that never lead to coordinated treatment. Over time, both conditions can become harder to manage, even when the patient continues seeking medical care.

What More Balanced Care Looks Like

Balanced care begins with recognizing that chronic pain and substance use concerns can exist together without one necessarily explaining the other. Having a history of substance use disorder shouldn’t mean every pain complaint is treated with suspicion.

In practice, this means taking the time to understand how pain affects daily life, reviewing medical history, and investigating symptoms before making treatment decisions. Medication monitoring and screening tests can still be part of the process, provided they’re applied consistently and their results are properly explained.

Open conversations are equally important. Patients should feel comfortable discussing their pain, medication concerns, and previous substance use without worrying that honesty will affect their treatment.

When both conditions need attention, primary care physicians, pain specialists, and addiction medicine professionals can work together to develop a suitable treatment plan. Regular follow-ups also allow room for adjustments as symptoms, treatment needs, or medication-related risks change. 

Frequently Asked Questions

Can chronic pain affect mental health?

Yes, living with chronic pain can affect emotional well-being, sleep, concentration, and relationships. Persistent discomfort can also contribute to stress, anxiety, and depression. These challenges can influence how people cope with daily activities, making emotional support an important part of long-term pain management.

What is the difference between physical dependence and addiction?

Physical dependence occurs when the body adapts to a medication, potentially causing withdrawal symptoms if it’s stopped abruptly. Addiction involves compulsive substance use despite harmful consequences. Someone can develop physical dependence on prescribed pain medication without having a substance use disorder.

Can chronic pain be managed without opioids?

Yes, depending on the underlying condition, treatment may include physical therapy, non-opioid medications, exercise programs, and psychological approaches such as cognitive behavioral therapy. Some patients benefit from combining several methods, although treatment choices depend on individual symptoms, health conditions, and response to care.

Key Research Findings at a Glance

Better Care Begins With Better Judgement

Living with chronic pain is difficult enough without having to worry about whether medical professionals will take your symptoms seriously. While concerns about substance use are understandable, they shouldn’t prevent anyone from receiving appropriate treatment. 

Clinical assessments, screening tools, and medical histories all have a role in guiding safe decisions, but none can fully capture someone’s experience of pain. Ultimately, good medical care depends on considering the complete picture, including what patients themselves have to say. As awareness of medical bias grows, there’s hope for a healthcare approach where caution and compassion can comfortably coexist.

Alice Turing

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I'm Alice and I live with a dizzying assortment of invisible disabilities, including ADHD and fibromyalgia. I write to raise awareness and end the stigma surrounding mental and chronic illnesses of all kinds. 

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