In primary care, family physicians often face patients whose physical illnesses are deeply influenced by social determinants of health. Managing chronic pain becomes particularly challenging when combined with domestic violence, alcohol misuse, and social vulnerability. This case illustrates how social adversity can shape clinical outcomes and therapeutic responses, creating new challenges for healthcare systems.We present the case of a middle-aged woman, a frequent attender in our practice, with a long history of chronic coxalgia that ultimately required bilateral hip prostheses. Beyond her physical illness, she lives in a highly complex social environment marked by domestic violence and lack of family support. She developed alcohol dependence, which progressed to cirrhosis and gastroesophageal varices. During an emergency hospital visit, physicians unfamiliar with her background prescribed opioid analgesics. Since then, she has developed opioid dependence, and attempts to taper and discontinue have been unsuccessful.This case highlights the intersection of chronic pain, social adversity, and iatrogenic harm. It shows how lack of continuity of care and limited awareness of context can exacerbate vulnerability, leading to new health problems such as opioid dependenceThis experience demonstrates that comprehensive care must extend beyond physical treatment and include understanding of the patient’s social reality. Continuity of care is essential to avoid inappropriate clinical decisions, and complex cases demand multidisciplinary approaches involving social services and mental health support. Opioid prescribing must be cautious and contextualized, as vulnerable patients face high risk of dependence. Finally, the role of the family physician is not only to treat symptoms but also to defend patient autonomy, ensure fairness in access to care, and foster solidarity in clinical relationshipsThis case emphasizes the need to integrate a biopsychosocial perspective into practice. Although prosthetic surgery improved mobility, unresolved social issues and alcohol misuse perpetuated suffering. Introduction of opioids without contextual knowledge worsened her condition, revealing how lack of coordination between care levels can lead to harmChronic pain cannot be managed in isolation from the patient’s reality. Family physicians must promote holistic care, ensure continuity, and apply prudent prescribing. Addressing vulnerability requires collaboration across medical, psychological, and social domains to improve outcomes