The Role of Childhood Trauma in Chronic Pain and Substance Use Among Individuals Receiving Methadone Treatment for Opioid Use DisorderThe Role of Childhood Trauma in Chronic Pain and Substance Use Among Individuals Receiving Methadone Treatment for Opioid Use Disorder
Addiction Medicine: Beyond the Abstract
Dr Joao De Aquino discusses research linking childhood trauma with chronic pain and substance use in people receiving methadone for opioid use disorder. The conversation highlights emotional abuse, fragmented services, and practical steps towards trauma-informed, integrated care.
23:24•24 Jul 2026
Childhood Trauma, Chronic Pain and Methadone: Joining the Dots in Opioid Use Disorder
Episode Overview
- Higher levels of childhood trauma, especially emotional abuse, are linked to greater pain severity, more alcohol use and earlier cannabis use among people receiving methadone for opioid use disorder.
- Emotional abuse may reshape the brain’s opioid and stress systems and disrupt emotional regulation, making substances feel more rewarding and their downsides weaker.
- Pain, trauma and substance use are deeply intertwined, yet clinical services often split them apart, leaving patients without truly holistic care.
- Routine screening for trauma and pain in addiction settings, followed by matched, trauma-informed and pain-focused interventions in a sensible sequence, can form a workable care framework.
- Clinicians are urged to resist fragmenting patients, hold science and compassion together, and view addiction, pain and trauma as parts of a single life story.
“Your patient has one brain and one life story.”
Understand the complexities of addiction with insights from clinician–scientist Dr Joao De Aquino, who talks about why pain, trauma and substance use can’t be treated as separate issues. Aimed at people interested in addiction medicine, this conversation looks closely at individuals receiving methadone for opioid use disorder and how childhood experiences still echo in their adult lives. Dr De Aquino explains that early adversity is common in this group, but what really stood out was the **dose** of trauma.
Using standard tools to measure childhood trauma, pain severity and recent substance use, his team found that higher trauma scores were linked to more severe pain, greater alcohol use and earlier cannabis use. Emotional abuse – being “demeaned, called names, made to feel unloved or worthless” – showed the strongest and most consistent connection with pain and alcohol patterns.
He outlines two main pathways that might explain this: biological changes to the brain’s opioid and stress systems, and disrupted emotional development that leaves people without healthy ways to handle distress. As he puts it, early trauma can “turn up the reward and turn down the brakes” on substances, making drugs feel better and their downsides weaker. The episode speaks directly to how services are set up.
Addiction care, pain clinics and trauma treatment often work in silos, and patients “fall into that gap”. Dr De Aquino argues for routine screening for trauma and pain, trauma-informed approaches, and integrated models that stabilise opioid use disorder first, then address trauma and pain in a planned sequence.
He ends with advice for current and future clinicians: resist fragmenting patients, “get comfortable holding science and compassion in the same hand”, and remember that “your patient has one brain and one life story.” If you care about joining up pain, trauma and addiction treatment, what changes could you bring into your own practice or recovery journey?
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