Addiction in Patients With Chronic Pain

Michael R. Clark, MD, MPH, MBA, Joyce King, MD, and Glenn J. Treisman, MD, PhD

Michael R. Clark, MD, MPH, MBA
Associate Professor & Director, Chronic Pain Treatment Program
Department of Psychiatry & Behavioral Sciences
The Johns Hopkins Hospital
Baltimore, MD

Joyce King, MD
Chair, Patient Care Advisory Committee
Director, Inpatient Training for Family Practice Residents
Franklin Square Hospital
Baltimore, MD

Glenn J. Treisman, MD, PhD
Professor of Psychiatry and Behavioral Sciences and of Medicine
Director, AIDS Psychiatry Service
The Johns Hopkins University School of Medicine
Baltimore, MD

Some fraction of opioid-treated patients with chronic pain will engage in aberrant substance use, including compulsive drug seeking and addiction. The public health burden of substance abuse and increasing rate of prescription drug overdose require prescribers to assess their patients for risks related to opioid misuse and abuse before prescribing. Individuals with the disease of addiction can be particularly challenging, necessitating highly structured therapy, alternative approaches to treatment and/or referral to experts in substance abuse issues. Here, Drs Treisman, Clark, and King discuss the overlapping neurobiology of addiction, affective disorders and pain. The panel also addresses the need to identify those individuals who are not doing well on opioid therapy and change the course of treatment rather than continue titrating doses up in an effort to improve patient function.

References

1.    Kircher S, Zacny J, Apfelbaum SM, et al. Understanding and treating opioid addiction in a patient with cancer pain. J Pain. 2011;12:1025-1031.
2.    Carinci AJ, Mao J. Pain and opioid addiction: what is the connection? Curr Pain Headache Rep. 2010;14:17-21.
3.    Barry DT, Irwin KS, Jones ES, et al. Opioids, chronic pain, and addiction in primary care. J Pain. 2010;11:1442-1450.

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