This course will describe approaches to managing complex pain management from three different dueling perspectives highlighting the multiple ways to approach complex pain management cases. In this course two clinical pharmacist specialists in pain management and a board certified addiction medicine physician, who currently practice on addiction consult teams at large academic medical centers, will dive into the various approaches to treating various patient case examples from their own practices who experience multiple pain generators, overlapping comorbidities, and/or characteristics that increase risk for select treatment options. Specific cases representing patients with acute on chronic, subacute on chronic, substance use disorder with pain, and/or multiple chronic overlapping pain conditions, will be presented and each speaker will describe their approach to pain and substance use assessment, triaging which pharmacologic treatment is started, modified, or discontinued, and how the patient specific factors influence clinical decision making. The presentation will conclude with key takeaways clinicians and multidisciplinary team members can incorporate within their own practice in patients with such pain management complexities.