Why Everything Hurts in Opioid Withdrawal: A Pharmacist’s Guide to Helping Patients

By Ashley Y., Addictions/Mental Health Pharmacist

Let’s be real: opioid withdrawal is one of those things we learn about in school, but how often do we really sit down and think through the lived experience of it—and how that impacts our role as pharmacists.

Before I started working in addictions and mental health, I knew the textbook symptoms: chills, nausea, muscle aches, anxiety , but I didn’t fully grasp how unbearable it can feel for patients until I saw it firsthand.

So let’s talk about it—not just the “what,” but the “why”—and how we can actually show up for our patients instead of just rattling off a med list and hoping for the best.

The Brain on Opioids: Why the System Crashes

When someone uses opioids regularly, the body adapts. Opioids bind to mu-opioid receptors in the brain and spinal cord, turning down pain signals, slowing the nervous system, and creating that warm, fuzzy sense of calm.

The brain sees this and goes, “Oh cool, you’ve got this covered—I’ll just stop making my own painkillers.” Natural endorphin production drops. The descending pain modulation system—the brain’s “mute button” for pain—leans on opioids to keep things chill.

Then the opioids disappear, and the brain is like, Wait… what just happened?

Cue the system-wide freakout.

Why Does Everything Hurt So Bad?

Here’s the thing: withdrawal isn’t just about missing the opioids. It’s about your nervous system flipping out because it doesn’t know how to regulate itself anymore.

Enter opioid-induced hyperalgesia—a fancy term for when the body’s pain system goes into overdrive. That 1/10 ache? Feels like a 6 or 7. Your pain threshold has collapsed.

The body’s own pain suppression system is offline. The brain is flooded with norepinephrine and other stress chemicals—The nervous system is overstimulated. It’s like every nerve ending is screaming!!

This is why patients say everything hurts—muscles, joints, even fabric brushing against skin.

What Pharmacists Can Actually Do About It

This is where we come in—not just as the medication experts, but as human beings who can explain the why and provide practical, compassionate care.

1️⃣ Symptom Management = Supportive Care

Withdrawal is not “just ride it out” territory. We have the tools to help our patients get through it comfortably and safely.

Clonidine: Calms the sympathetic storm—helps with anxiety, sweating, and muscle aches.

• Monitor: BP and HR—watch for hypotension and bradycardia.

• Red flags: Don’t use in patients with baseline hypotension or heart block.

• Follow-up: Check vitals regularly; adjust as needed.

Loperamide (Imodium): For diarrhea—because dehydration is not a vibe.

• Monitor: Bowel movements, signs of misuse (yes, people do misuse it).

• Red flags: High doses = cardiac risk, mild high. Don’t let patients load up.

• Follow-up: Check for improvement; hydration status.

Ondansetron: Nausea and vomiting? Covered.

• Monitor: QT prolongation risk—especially in combo with other QT meds.

• Red flags: Electrolyte imbalances, prolonged QTc.

• Follow-up: Ask if it’s helping; adjust as needed.

NSAIDs (ibuprofen, naproxen): For muscle and joint pain.

• Monitor: GI and renal function.

• Red flags: Peptic ulcers, renal impairment, bleeding risk.

• Follow-up: Pain relief vs side effects.

Hydroxyzine, Trazodone: Sleep/anxiety support if appropriate.

• Monitor: Sedation, anticholinergic effects.

• Red flags: Elderly patients, urinary retention risk.

• Follow-up: Check sleep patterns, drowsiness.

2️⃣ Opioid Agonist Therapy (OAT) = Gamechanger

Let’s stop treating buprenorphine/naloxone and methadone like “last resort” options. They are first-line for opioid use disorder. This can also apply during the withdrawal phase as well.

These meds stabilize the system, reduce hyperalgesia, and make withdrawal way more manageable. They’re not “replacing one drug with another”—they’re treating a medical condition.

Our role? Educate, advocate, and help patients access OAT. That’s how we save lives.

3️⃣ The Human Side: Listening and Empathy

Withdrawal isn’t just a list of symptoms—They’re exhausted, anxious, and often flooded with emotions of guilt and shame on top of it all.

When we get the neurobiology, we can explain it like this:

“Your brain was relying on opioids to manage pain and stress. Now that they’re gone, your system is in overdrive. That’s why everything hurts and you feel so awful—but it will pass.”

That’s not just education—it’s validation. It’s empathy. And it matters.

Why This Knowledge Matters for Us as Pharmacists

If you’re a pharmacist or student reading this, you might be thinking, “Okay, cool—good to know. But how does this change what I do in practice?”

Here’s the thing: withdrawal is a critical moment. Patients in withdrawal are at high risk for relapse, overdose, and dropping out of care.

If we can:

✅ Ease their symptoms

✅ Explain what’s happening in their body

✅ Connect them to OAT or other resources

…we’re not just filling scripts. We’re practicing harm reduction. We’re helping people survive one of the hardest things they’ll ever go through.

Final Thoughts

Opioid withdrawal is brutal. It’s a neurochemical storm that hijacks the body and mind. But as pharmacists, we have the knowledge—and the responsibility—to make it more bearable.

By understanding the why behind the pain, we can help patients feel seen, heard, and supported. That’s what real patient care looks like.

Let’s keep learning, stay curious, and remember: we’re not just dispensing meds—we’re helping people navigate some of the hardest moments of their lives.