Chronic pain may be due to severe diseases, such as cancer, diabetes, or sickle cell disease, or there may be no disease explanation. When the pain becomes severe and disabling, for whatever reason, patients become depressed, anxious, and often have substance use problems. Even when using the effective psychological treatments for these three conditions, the chronic pain itself often persists as a disabling problem. Not only is that the seed of opioid use problems but it also requires long-term care by a well-trained, caring clinician who can effectively establish a strong relationship with the patient. This seldom occurs.
