Abuse and Addiction Issues in Medically Ill Patients With Pain: Attempts at Clarification of Terms and Empirical Study

Abstract

The assessment of addiction-related outcomes is crucial to the management of chronic pain with opioid drugs in all patients. Pain management for patients who have concomitant drug abuse or addiction issues is a particularly complex task involving a need for a common nomenclature as well as empirically derived data to support management strategies during treatment regimens. Complicating the issue is the notion of pseudoaddiction, which is an abuse of medications driven by unrelieved pain that appears on the surface to be very similar to the behavior patterns of addicts. For proper adherence to medical therapy and safety during treatment, it is necessary to address and manage substance abuse-related behaviors. Aberrant drug-taking behavior presents many threats to the integrity of pain treatment. Unfortunately, the current state of the art still has a long way to go before clear guidelines for treatment and management can emerge. What is ultimately needed is a broad-based spectrum of research that highlights the epidemiology of drug-taking behaviors for different medical illnesses ranging from cancer to back pain. This article focuses on some of these issues as well as recounting attempts by our research group to address these issues systematically in hopes of shedding light on the nature of abuse issues in the medically ill. Although advances have been made, there is a definite need for large-scale studies that address the issues of identification and treatment of aberrant behavior in medically ill patients in the effort to provide the best possible outcomes for patients with chronic pain.

Development and validation of the Current Opioid Misuse Measure

“…Addiction is a primary, chronic, neurobiologic disease that is characterized by behaviors that include one of more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Aberrant drug-related behaviors are any behaviors that suggest the presence of substance abuse or addiction (Kirsh et al, 2002;Nedeljkovic et al, 2002).…”

Psychische Komorbidität bei Krebserkrankungen

“…Da Alkohol-und Tabakabusus Risikofaktoren für bestimmte Tumorerkrankungen darstellen, ist die Abgrenzung zu bereits vor der Krebserkrankung bestehenden Abhängigkeitsstörungen schwierig. Wenige empirische Studien liegen darüber hinaus zur Medikamentenabhängigkeit von Krebspatienten mit starken, chronischen oder inadäquat behandelten Schmerzen vor [36].…”

The Pharmacotherapy of Chronic Pain: A Review

“…The assessment of addiction in pain treatment settings has received increasing attention, and there are a number of excellent reviews to assist clinicians in the assessment and treatment of patients with comorbid chronic pain and addiction (188)(189)(190)(191). The Liason Committee on Pain and Addiction (a joint committee with representatives from the American Pain Society, American Academy of Pain Medicine and American Society of Addiction Medicine) in the USA was formed in July 1999 to encourage collaboration between pain and addiction specialists on issues of common interest, including research, education, clinical care and policy development (189).…”