Lachlan Townend sits down with Dr Lisa Shelley, a general physician and addiction medicine specialist at Currumbin Clinic, to talk about one of the most stigmatised overlaps in healthcare: chronic pain and substance use.

Lisa explains what addiction actually is, and why a high dose of a prescribed opioid doesn’t, on its own, mean someone has an opioid use disorder. She walks through how “liking” becomes “unwanted wanting” in the brain, why opioids lose their benefit for chronic pain (“there is no top to that mountain”), the danger of adding pregabalin to an opioid, and how buprenorphine keeps people alive.

The conversation also covers the signs of opioid misuse, whether opioid-induced hyperalgesia is as common as we think, and the first step for anyone worried about their own use. Lisa shares the recovery skill she teaches every patient, learning to “sit in the mud”, and why fun belongs alongside sleep, food and movement.

Whether you’re a clinician, living with chronic pain, or a worried family member, this is a compassionate, practical and hopeful conversation.

Disclaimer: This podcast is not personalised medical advice. Please consult a health professional before acting on anything discussed.

RESOURCES:

• Pain Coach: turns complex chronic pain into simple habit targets. Free for early adopter clinics: paincoach.co
• Dr Lisa Shelley: Currumbin Clinic profile
• Tame the Beast: a short animation on understanding persistent pain
• THIS WAY UP Chronic Pain Program: a free online course
• National Alcohol and Other Drug Hotline: 1800 250 015, free and 24/7
• Peer support: NA, AA, SMART Recovery, Recovery Dharma

KEY TOPICS:

00:00 – Teaser
02:01 – Leading with validation: how Lisa works with patients
09:18 – What is addiction? Dependence vs opioid use disorder
12:57 – The neurobiology of addiction: from liking to “unwanted wanting”
18:02 – Substance use in the context of chronic pain
20:05 – Medicinal cannabis for chronic pain
21:26 – The most common substance problems in chronic pain
22:42 – Overdose deaths and how buprenorphine keeps people safe
28:18 – Treating an opioid problem with opioids?
31:52 – Learning to “sit in the mud”
35:10 – Why there’s “no top to that mountain” with opioids
36:28 – The danger of combining pregabalin and opioids
37:11 – Signs of opioid misuse to look out for
42:27 – Is there a safe opioid dose?
46:28 – Opioid-induced hyperalgesia: how common is it?
49:09 – Opioid documentaries and the OxyContin story
54:24 – Worried about your own use? The first step
55:42 – Where to get help in Australia
58:39 – The non-negotiables: sleep, food, movement, connection and fun
1:00:45 – Pain science education and Lisa’s own back pain
1:03:51 – Lisa’s advice for someone in pain right now