Managing pain in the addicted patient

Abstract

Approximately 20 million Americans have some form of substance abuse disorder, and about one-third of the US population has used illicit drugs (Substance Abuse and Mental Health Services Administration office of Applied Studies 2007). Substance abuse is known to occur in 10-16% of outpatients in general medical practice, 25-40% of hospital admissions, and 40-60% of major trauma patients (Manchikanti et al. 2003, Rosenblatt and Mekhail 2005). In chronic pain management settings, illicit drug use has been reported in 14-34% of patients (Manchikanti et al. 2006). Among the illicit drugs, use of marijuana is reported most common, followed by that of cocaine, hallucinogens, and methamphetamines. Such high prevalence of illicit use, along with concerns of drug abuse and addiction, and its association with life-threatening pathophysiological effects, often has a negative influence on pain treatment. Pain patients who have current or remote histories of drug abuse present a multitude of medical and psychosocial issues that hinder pain and symptom management. Physicians are often not well-versed with the conceptual or practical issues related to addiction, which causes difficulty in treating these patients effectively. In chronic pain patients, the high incidence of illicit drug use is intimately linked to opioid and prescription drug dependence, as well as to the psychosocial, cultural, and environmental factors that affect these individuals. © 2011 Springer Science+Business Media, LLC.