**7. Conclusion**

Patients who are living with chronic pain and a history of SUD and are attempting to improve their quality of life and avoid unhealthy substance use are to be credited

for their resilience, courage, and perseverance in staying "within the system" and entrusting their care to a team of providers. Often, these patients are the victims of stigma and judgment, experiencing negative interactions with individual providers and with the health care system as a whole. Today's unprecedented levels of fatal drug overdoses necessitate a shift toward harm reduction and toward a willingness to partner with patients whose choices do not always perfectly align with prescribed recommendations, so that we may help them avoid making their last dangerous choice. With the right approach, these patients can be offered safe, effective, holistic care that aims to address the various domains of their suffering, including physical symptoms, emotional distress and trauma, and disengagement from meaningful activity. Best results are generally found when a team of professionals provides coordinated interdisciplinary care. When such care is impractical or unavailable, individual components of evidence-based interventions and approaches can still be pursued with excellent patient-centered results, and with fulfilling, gratifying longterm relationships between patients and providers.
