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Chronic Pain Management with Opioids in Patients with Past or Current Substance Abuse Problems

Interdisciplinary Pain Management and Primary Care Clinics (VAMC), Albany College of Pharmacy, and American Pharmaceutical Care Pain Consultants, fudinj{at}acp.edu

Deborah J. Levasseur, PhD

Interdisciplinary Pain Management and Primary Care Clinics (VAMC)

Steven D. Passik, PhD

Symptom Management and Palliative Care Program, Markey Cancer Center, University of Kentuck

Kenneth L. Kirsh, PhD

Symptom Management and Palliative Care Program, Markey Cancer Center, University of Kentuck

John Coleman, MS, MA

Drug Enforcement Administration: Law Enforcement and Office of Diversion Control

Among patients who present to medical providers with chronic pain complaints, there is an elevated prevalence of illicit substance use and prescription misuse. For those with legitimate pain, this predicament potentiates the risk of being medically underserved or undertreated. Complicating factors include a lack of specificity and sensitivity to the issue of defining substance abuse or misuse in the health care setting. Irrespective of whether patients have histories of addiction, problematic behavior manifests during the course of chronic pain therapy, making a conceptualization of the nature and function of this behavior difficult. The objective of this article is to highlight known confounds in the assessment of "normal" pain-related vs. substance abuse behavior. Our aim is to offer important points to consider, a set of systematic guidelines to follow, and an armamentarium of essential tools to facilitate contingency management planning in the context of treating chronic pain with controlled substances.

Key Words: Chronic pain management • substance abuse • pseudoaddiction • opioid therapy • controlled substances.

Journal of Pharmacy Practice, Vol. 16, No. 4, 291-308 (2003)
DOI: 10.1177/0897190003258507


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