**4.4 Other medications useful in co-occurring chronic pain and SUD**

In the management of chronic pain, typically a combination of agents is prescribed to provide analgesia using different neurochemical pathways [17]. Opioids should be used only when other non-opioid medications, and non-pharmacologic pain management strategies, have failed to adequately address pain severity and associated functional impairment [6]. Patients with active SUD, and/or a personal or family history thereof, should even more pointedly be recommended to avoid controlled substances which may trigger unhealthy substance use in a manner that is unsafe and counterproductive to the goals of treatment. Examples of commonly used non-opioid medications include the following [17]:


both of which are approved for diabetic peripheral neuropathy and post-herpetic neuralgia, the latter also approved for fibromyalgia. Carbamazepine, valproic acid, and other agents have been used effectively for paroxysmal facial pain and headache syndromes. All medications in this category have potential for significant adverse effects and tolerability issues.

