Treating Chronic Nonmalignant Pain: Issues and Misconceptions

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US Pharmacist CE

Release Date: September 2002

Expiration Date: September 30, 2004

" Treating Chronic Nonmalignant Pain: Issues and Misconceptions " :

http://www.uspharmacist.com/index.asp?page=ce/nonmalignant/default.htm

" Addiction, physical dependency, tolerance: Some of the concerns

regarding opioid use have stemmed from misconceptions or confusion

regarding the risks of addiction, tolerance and physical dependence.

Addiction or psychological dependence is a behavioral disorder

characterized by aberrant drug-related behaviors in order to obtain

these drugs. Addiction is very rare in patients receiving opioids for

pain management unless they had a predisposition to substance abuse

prior to their painful condition. The Boston Collaborative Drug

Surveillance Project reported only four cases of addiction among 11,882

hospitalized patients (with no history of substance abuse) who received

at least one dose of an opioid drug.29 In patients receiving opioids for

pain management, evidence of addiction or abuse may include a loss of

control of opioid use, preoccupation with opioid use despite adequate

pain relief, and continued preferential use of opioids despite obvious

adverse effects.6,30,31 The term pseudoaddiction describes patients who

have severe, unrelieved pain and who exhibit a preoccupation with

obtaining opioids.32 It is distinguished from true addiction because

when patients exhibiting pseudoaddiction receive effective pain

management, they are compliant with therapy and do not seek other means

to obtain opioids.

Physical dependency is the precipitation of an untoward reaction if a

drug is abruptly withdrawn or an antagonist is administered. It is often

confused with addiction and does occur in patients who receive long-term

therapy with opioids regardless of whether they have pain or not. It is

an expected consequence of long-term opioid therapy, just as it is with

corticosteroids or beta-blockers. Symptoms commonly associated with

abrupt withdrawal of opioids include anxiousness, tremor, abdominal

pain, increase in blood pressure, and sweating. Some degree of physical

dependence should be assumed if a patient has received regular doses of

opioids for more than five to seven days.22 If opioid therapy is to be

discontinued, the dose should be gradually tapered (similar to therapy

with corticosteroids) to avoid withdrawal symptoms. "

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org