Much of our work is organised around labels – addiction, long-term or harmful substance use, chronic pain, mental health, trauma.
Each has its own professional language, evidence base and service structure. Those distinctions matter, and specialist expertise is essential. But in separating these experiences into different systems, we can sometimes lose sight of the person at the centre.
One of the biggest advances in recent years has been our understanding of trauma and the nervous system. Yet I wonder whether we’ve fully appreciated what this means. Modern pain science has embraced this understanding, recognising that chronic pain is often not simply a measure of tissue damage but a real experience created by the nervous system and influenced by previous experiences, emotions, environment and our sense of safety.
Trauma and prolonged stress can leave the nervous system in a heightened state of protection. Pain, fear and hypervigilance become closely intertwined. That doesn’t mean the pain is ‘psychological’ – the pain is entirely real. But it’s shaped by much more than damaged tissue.
For those of us working with people experiencing long-term or harmful substance use, this feels strikingly familiar. Many people are not simply seeking pleasure or taking risks. They’re trying to regulate an overwhelmed nervous system, numb emotional pain, cope with trauma, sleep, reduce anxiety, or simply get through another day.
This doesn’t mean that chronic pain and harmful substance use are the same – they’re not. Nor does it mean that everyone who uses substances has experienced trauma. But both fields increasingly recognise that behaviour often makes sense when viewed as an attempt to cope with suffering rather than simply as a problem to be eliminated.
The scale of chronic pain makes this impossible to ignore. More than one in four adults in England live with chronic pain, with around one in eight experiencing pain that significantly limits daily life. Up to half of GP consultations relate to pain, with musculoskeletal conditions alone costing the NHS almost £5bn each year.
Yet our systems continue to separate physical pain, mental health and substance use into different pathways. At the same time, while we’ve become much better at recognising trauma and psychological wellbeing, we sometimes pay less attention to the social conditions that shape suffering in the first place – poverty, insecure housing, loneliness, unemployment and inequality all affect the nervous system, physical health and people’s ability to recover.
This is where social inclusion organisations have an important contribution to make. At DHI, our interest in pain has grown directly from listening to the people we support. Time and again we’ve seen chronic pain, trauma, harmful substance use and social exclusion reinforce one another, yet too often they’re addressed by different services in isolation. That has led us to ask whether social inclusion organisations have a greater role to play in helping people understand and manage persistent pain alongside the wider challenges they face.
Our role has always been to see the person beyond the diagnosis or behaviour. Recovery has never been simply about stopping substance use – it’s about rebuilding lives, relationships, confidence and hope.
The same principle applies to chronic pain. Success is not always measured by a lower pain score. Sometimes it means sleeping better, reconnecting with family, returning to work, reducing reliance on medication or feeling able to participate in life again.
As DHI prepares to launch its pain management and wellbeing toolkit, we’re not suggesting that we have all the answers or that we’re seeking to replace specialist pain services. We’re asking whether these fields have more to learn from one another.
Substance use services have developed expertise in trauma-informed practice, peer support, motivational approaches and recovery capital. Pain services bring an increasingly sophisticated understanding of the nervous system and how people can regain confidence and function despite persistent pain. Perhaps the future is not about creating more labels, but about becoming better at understanding what connects people across them.
Because behind every diagnosis, every label and every behaviour, is a person trying to find a way through.
Rosie Phillips is chief executive of Developing Health & Independence (DHI)