You expected withdrawal to be tough, but you got through the worst of it. The cold sweats, nausea, and body aches faded, and you thought you were finally in the clear. But weeks—or even months—later, something feels off. You’re exhausted, moody, struggling to focus, and sometimes it feels like your emotions are completely numb. It’s not physical withdrawal anymore, but you still don’t feel normal.
This is Post-Acute Withdrawal Syndrome (PAWS), a condition that affects many people recovering from opioid use. Unlike the intense physical symptoms of early withdrawal, PAWS brings unpredictable waves of emotional, cognitive, and energy-related struggles that can last for months. If you don’t know what’s happening, it can feel like you’re stuck in limbo, unsure if recovery will ever feel easier.
But don’t worry, PAWS is temporary—and recognizing it is the first step to managing it. In this article, we’ll break down:
- The difference between acute withdrawal and PAWS
- Common PAWS symptoms and how long they last
- What to do if PAWS symptoms don’t improve
The Difference Between Acute Withdrawal and PAWS
Many people assume that once they get through the initial withdrawal phase, they’ll start feeling better. But opioid recovery isn’t always that simple. Acute withdrawal and PAWS are two distinct phases of recovery, and understanding the difference can help you manage symptoms more effectively.
What is Acute Withdrawal?
Acute withdrawal is the first phase of withdrawal, occurring in the first few days to two weeks after quitting opioids. This phase is primarily physical, as the body reacts to the absence of opioids.
Common symptoms of acute withdrawal include:
- Muscle aches and body pain
- Sweating and chills
- Nausea, vomiting, and diarrhea
- Restlessness and insomnia
- Anxiety and irritability
- Intense opioid cravings
Acute withdrawal symptoms peak around days 2-4 and gradually improve over 7-14 days, though some people may experience lingering effects for a few weeks.
What is PAWS?
PAWS, or Post-Acute Withdrawal Syndrome, occurs after acute withdrawal ends—often weeks or months into recovery. Unlike acute withdrawal, PAWS is more psychological than physical, making it harder to recognize and manage.
PAWS is caused by:
- Dopamine depletion – Opioids disrupt dopamine production, leading to long-lasting mood and motivation struggles.
- Neurochemical imbalances – The brain takes time to adjust to functioning without opioids, leading to lingering emotional and cognitive symptoms.
- Triggers and stress responses – The brain still associates opioids with relief, which can cause unexpected cravings and emotional swings.
How is PAWS different from acute withdrawal?
- PAWS develops later (weeks to months after quitting) rather than immediately.
- PAWS lasts longer—it can persist for months or even up to a year.
- PAWS is more unpredictable—symptoms come and go in waves rather than improving steadily
Common PAWS Symptoms and How Long They Last
PAWS symptoms can be frustrating because they don’t follow a predictable pattern. Some days, you may feel completely fine, while other days, symptoms return suddenly and intensely. This can make recovery feel like an emotional rollercoaster, but understanding these symptoms can help you recognize what’s happening and take action.
Emotional and Psychological Symptoms
One of the most difficult aspects of PAWS is the emotional instability that comes with it. Since opioids artificially boosted dopamine levels, the brain struggles to produce enough on its own after quitting. This leads to:
- Mood swings that come and go without an obvious trigger
- Anxiety that feels overwhelming, even in normal situations
- Depression or an inability to feel pleasure from everyday activities
- Irritability, frustration, and a short temper
- Feelings of detachment or emotional numbness
Many people worry that these feelings mean they are permanently damaged, but this is part of the brain’s healing process. Over time, dopamine levels will regulate, and emotions will feel more stable.
Cognitive Symptoms
PAWS can make it hard to think clearly, process information, or stay motivated. Some people describe it as feeling like their brain is stuck in slow motion. This can lead to:
- Brain fog, making it difficult to concentrate
- Short-term memory problems and forgetfulness
- Difficulty processing emotions or making decisions
- Feeling mentally exhausted, even after doing simple tasks
This phase can be frustrating, but cognitive function gradually improves as the brain’s neurotransmitters rebalance.
Physical Symptoms
Although PAWS is mostly psychological, some physical symptoms can linger for months after quitting opioids. These include:
- Chronic fatigue that doesn’t improve with rest
- Sleep disturbances, including trouble falling asleep or staying asleep
- Headaches, muscle tension, or unexplained body aches
- Increased sensitivity to pain, cold, or stress
- Digestive issues like nausea or stomach discomfort
Physical symptoms in PAWS are usually caused by lingering imbalances in the nervous system. As the body and brain heal, these symptoms gradually lessen.
How Long Does PAWS Last?
The duration of PAWS varies from person to person, depending on factors like how long opioids were used, individual brain chemistry, and overall health.
- In most cases, PAWS symptoms come and go for six months to a year.
- The first one to three months tend to be the hardest, with symptoms at their most intense.
- By six months, many people notice symptoms becoming less frequent and less severe.
- By one year, most PAWS symptoms fade, though some may experience occasional mood swings or fatigue.
PAWS does not last forever. The brain and body continue to heal, and symptoms become more manageable over time.
What to Do if PAWS Symptoms Don’t Improve
PAWS symptoms can be discouraging, especially when they persist for months. Many people in recovery worry that they’ll never feel normal again. While PAWS is temporary, it requires active management to speed up the healing process and reduce symptoms. If you feel stuck in PAWS, there are steps you can take to help your brain and body recover more effectively.
Stay Consistent with Healthy Habits
Since PAWS symptoms fluctuate, it’s easy to fall into cycles of feeling better and then backsliding into unhealthy routines. Establishing structure can help stabilize your mood and energy levels.
- Stick to a consistent sleep schedule, even if insomnia is an issue
- Eat a balanced diet with protein, healthy fats, and complex carbs to regulate blood sugar
- Avoid excessive caffeine, sugar, and processed foods, which can cause energy crashes
- Engage in regular movement like walking, stretching, or low-impact workouts to support dopamine production
Consistency is key. The more you repeat these habits, the more your brain adapts, and PAWS symptoms start to fade.
Address Underlying Mental Health Issues
Some symptoms of PAWS overlap with anxiety, depression, and PTSD, which are common among people in opioid recovery. If PAWS symptoms don’t improve after several months, an untreated mental health condition could prolong your struggles.
- Consider therapy or counseling, especially if emotional symptoms are severe
- Cognitive Behavioral Therapy (CBT) can help reframe negative thought patterns and improve mood
- Trauma-informed therapy may be helpful if past trauma contributed to opioid use
- Medication may be an option if depression or anxiety remains unmanageable
Many people hesitate to seek mental health treatment because they assume PAWS will resolve on its own. Professional support can make a significant difference if symptoms persist beyond six months.
Medication-Assisted Treatment (MAT) for PAWS
For some people, medication can help regulate brain chemistry and reduce PAWS symptoms.
- Suboxone (buprenorphine/naloxone): Helps stabilize mood and reduce cravings
- Naltrexone: Blocks opioid receptors and reduces emotional instability
- Selective serotonin reuptake inhibitors (SSRIs): May help with persistent depression or anxiety
- Sleep aids (trazodone, melatonin): Can support healthy sleep cycles
If PAWS symptoms are affecting your ability to function, discussing medication options with a provider can be a useful step.
Build a Support Network
Recovery can feel isolating, and PAWS can make it even harder to reach out for help. Connecting with others in recovery can reduce frustration and help keep you accountable.
- Join support groups like NA, SMART Recovery, or online communities
- Find a sponsor or mentor who understands PAWS and can offer guidance
- Talk to friends and family about what you’re experiencing so they can provide encouragement
Having people who understand your struggles can make PAWS feel more manageable and less overwhelming.
Be Patient with Yourself
PAWS can feel like an unfair setback, but it is not a sign of failure. Your brain and body are still recovering, and healing takes time.
- Avoid comparing your recovery timeline to others—everyone heals at their own pace
- Recognize progress, even if it feels small—every day you stay clean is a step forward
- Trust that symptoms will fade over time, even if they feel persistent now
If PAWS symptoms are severe, persistent, or affecting your daily life, seeking medical support can provide relief and help speed up the healing process.
QuickMD: Expert Support for Managing PAWS and Long-Term Recovery
PAWS can make recovery feel exhausting, but you don’t have to go through it alone. QuickMD provides expert addiction care to help you manage lingering withdrawal symptoms, reduce cravings, and support your long-term recovery.
Why Choose QuickMD for Opioid Recovery?
- Same-day online appointments – Speak with a licensed addiction specialist from home.
- Medication-assisted treatment (MAT) – Suboxone and naltrexone can help stabilize mood and reduce cravings.
- Mental health support – QuickMD providers can assess symptoms of anxiety, depression, and PAWS-related emotional struggles.
- Affordable care – Follow-up visits are only $99 (medications not included).
- HIPAA-compliant telemedicine – Discreet and confidential treatment from anywhere.
How QuickMD Helps Manage PAWS Symptoms
- Personalized medication plans – Adjust Suboxone, naltrexone, or other medications to support brain recovery.
- Ongoing medical check-ins – Regular follow-ups to track progress and fine-tune treatment.
- Guidance on nutrition, sleep, and lifestyle changes to speed up PAWS recovery.
PAWS symptoms may feel overwhelming, but they don’t last forever—and with the right treatment, you can feel better faster.Don’t let lingering withdrawal symptoms hold you back. Schedule an appointment with QuickMD today and take the next step toward full recovery.
