Addictive Disorders and Pain

Abstract

The overlap of pain and addiction presents special challenges to the clinical treatment of both disorders. Some patients with histories of substance-use disorders or other risk factors for addiction who also suffer moderate-to-severe pain may be successfully managed using opioids when alternative treatments would be ineffective. For other patients, opioids may be ineffective, retrigger abuse, and clearly be the wrong treatment for the individual patient. Every clinician who provides opioids should be familiar with risk factors for opioid addiction and screen patients for possible addictive disorders, remembering that the spectrum of aberrant behaviors ranges from misuse to the disease of addiction. Effective ongoing management requires an understanding of the motivations underlying drug related behaviors and a recognition that not all substance use is addiction. Ongoing management is then tailored by setting the level of clinical monitoring appropriate to the degree of risk, reassessing the patient frequently, and being prepared to humanely taper the patient from opioids if necessary. (PsycINFO Database Record (c) 2019 APA, all rights reserved) (Source: chapter)