Pain and Addiction

Chronic pain is one of the most common reasons adults seek medical care. According to the 2016 National Health Interview Survey (NHIS) data, an estimated 20.4% (50.0 million) of US adults had chronic pain, with higher prevalence of chronic pain reported among women, older adults, previously but not currently employed adults, adults living in poverty, adults with public health insurance, and rural residents. Providing adequate pain control in patients with addictive disorders presents unique challenges. The medicinal value of opium has been acknowledged for centuries. Even though possessing a widespread side-effect profile, morphine, isolated from opium more than 200 years ago, remains the gold standard for treating pain. While relapse in a recovering individual may occur despite appropriate pain management, inadequate pain relief is also a risk factor for relapse. Some of the challenges that physicians face include distinguishing between seeking pain relief and seeking drugs for euphoric effects and identifying predictable neuroadaptations such as tolerance and physiological dependence that can be misinterpreted as drug-seeking behavior. In addition, comorbid psychiatric and medical illnesses may complicate effective pain management. This chapter addresses the following areas related to successful pain management in patients with an addictive disorder: (1) substance-abuse terminology, (2) active addiction versus recovery, and (3) management strategy for acute, chronic, and end-of-life pain.