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Patients requiring acute pain management may be opioid dependent as a result of either recreational or therapeutic opioid use, including those in opioid addiction programmes. Pain in these patients is often under‐estimated and under‐treated. In addiction, drug‐seeking behaviour differentiates it from simple dependence. With few randomised controlled trials, current evidence predominantly consists of guidelines based on case reports, retrospective studies and expert opinion. Consensus recommendations include maintaining regular provision of the patient's pre‐existing opioid requirement, with additional analgesia, ideally multimodal, in appropriate combinations of short‐acting opioid (as required), local anaesthesia, and adjuvant anti‐inflammatory analgesics and paracetamol. Patient controlled analgesia with higher bolus doses and shorter lock‐out intervals is a recommended strategy. Transdermal opioid …