Hyperalgesia is associated with chronic non-malignant pain (CNMP) treated with high dose opioids (HDOs). Amplification of chronic pain is often addressed with higher doses of opioids in a futile attempt to avoid perceived tolerance and address pseudo-addiction. A system of office based cognitive behavioral interventions (CBT), medical and physical management strategies designed to sustain effective pain management without HDOs is presented in this multi case study. Of a total 29 CNMP patients on HDOs completing induction of buprenorphine / naloxone therapy (BNT) 55% successfully transitioned to complete opioid withdrawal or maintenance on lower dose BNT. Overall, visual analog scores were substantially reduced or unchanged despite withdrawal of HDOs. Effectively instituting a step-down or exit strategy for patients on chronic opioids is time consuming and requires supportive cognitive interventions. Cognitive behavioral strategies employed in this study include: education of patients re a multidimensional view of pain, identification of pain-eliciting and pain-aggravating thoughts, emotions and behaviors, identification and modification of maladaptive cognition. Buprenorphine doses of 12-24 mg sublingual were initially utilized to reduce withdrawal symptoms associated with HDOs. Downward titration of BNT facilitates transition to lower potency but equally effective analgesics and/or non-opioid adjunctive agents for residual pain. Medication changes, applied in concert with a self-responsible physical exercise program, are reinforced with office based CBT techniques. Advantages to both the patient and practitioner in breaking the cycle of chronic pain and challenging prescription logistics in patients exhibiting signs of opioid hyperalgesia are illustrated. Educational materials, readily adaptable to individual patients and practitioners, may be developed utilizing components of this chronic pain management modular system. Step-down treatment of HDOs utilizing elements of CBT and BNT appears effective and well accepted by a majority of those exposed to this therapy.