Abstract

Chronic low back pain and opioid use disorder often occur together, creating clinical situations that are complex and emotionally charged. Low back pain remains a common cause of disability and a major contributor to opioid prescribing. Although guidelines recommend exercise and other non-opioid treatments as first-line care, patients with co-occurring opioid use disorder frequently have limited access to these services and are more likely to receive escalating opioid doses instead. Stigma, fragmented systems, and regulatory pressures further complicate care and strain clinical encounters. Integrated approaches that combine medication treatment for opioid use disorder with behavioral and rehabilitative pain strategies offer a more practical way to address both conditions at once. Emphasizing function, safety, and clear communication can help move care forward, even when broader structural barriers remain.