Introduction

Substance use disorders (SUDs) are commonly accompanied by shifts in emotional state and pain perception that may impair performance and undermine treatment. With evidence on opioid- and alcohol-induced hyperalgesia as well as the co-occurrence of chronic pain and dependence, it is crucial to shift the focus towards other substance classes. This review investigates evidence on pain dysregulation in the problematic use of nicotine, cannabinoids, psychostimulants, benzodiazepines and Z-drugs; it also presents oxidative stress as a plausible contributor to pain vulnerability.

Current knowledge

A consistent pattern emerges across drug classes: acute exposure may transiently dampen nociception, while chronic use and/or withdrawal can promote heightened pain sensiti­vity. Clinical evidence is strongest for nicotine; smoking is linked to greater pain burden and abstinence increases pain reactivity. For cannabinoids, early reports supported chronic-pain analgesia, recent findings show only a small benefit with more adverse events, and several studies associate long-term use with higher pain burden or reduced pain tolerance without establishing causality. For psychostimulants, the findings are substance-specific and predominantly pre-clinical. Evidence for benzodiazepine-related hyperalgesia is suggested primarily by observations of patient-reported with­- drawal symptoms, while Z-drug hyperalgesia remains hypothetical.

Conclusions

Pain dysregulation appears to be a cli­nically relevant, potentially transdiagnostic feature of non-opioid substance use, yet treatment strategies rarely include regimens specifically targeting pain relief. This review calls for longitudinal clinical studies with Harmonised Quantitative Sensory Testing and improved exposure characterisation (dose/potency/route/polysubstance use). Clinically,
it supports a shift toward integrated treatment models where pain assessment and evidence-based pain interventions accompany psychoactive de­pen­dent persons management to reduce relapse vulner­ability.