CONCERN ABOUT OPIOID ADDICTION AS A BARRIER TO ACUTE PAIN MANAGEMENT

Acute pain is undertreated for many people in the United States. Although opioid analgesics are extremely important tools for the treatment of acute pain, their appropriate use is often poorly understood by both clinicians and patients. Among other issues, confusion about the risk of dependence, tolerance, and addiction with opioid therapy is a significant contributor to the undertreatment of pain. Dependence (the presence of a withdrawal symptom upon drug discontinuation) is a feature of opioid therapy, but is also common with many other types of commonly used medications. Tolerance to the effects of opioids is an expected response to ongoing treatment. Addiction is a primary neurobiological disease that occurs extremely infrequently when patients without preexisting substance use disorders receive opioid treatment for acute pain. However, inadequate pain relief can cause behaviors that resemble addiction in some respects, a phenomenon that has been referred to as pseudoaddiction. Although the risk of addiction with acute opioid treatment is extremely low, rating scales to help identify patients who may benefit from closer monitoring for development of aberrant drug-related behaviors may be useful for some persons. Undertreatment of acute pain is a significant problem in the United States, which is at least partly attributable to the limited education about pain that most clinicians receive. Effective treatment of acute pain is essential to relieve patient suffering and improve quality of life, and it may also prevent the development of chronic pain. (Adv Stud Pharm. 2008;5(2):48-51)