Addiction and chronic pain: diagnostic and treatment dilemmas.

Chronic pain and addictive disorders present significant medical and public health problems; both are underdiagnosed and inadequately treated. The cooccurrence of pain and addiction adds complexity to the assessment and treatment of both disorders. Research on the link between pain and substance use disorders (SUDs) has focused on the bidirectional relationship between chronic pain and opioid dependence. While chronic opioid exposure alters physiological responsivity to painful stimuli, chronic pain also modifies the rewarding effects of opioids. Although the relationship between alcohol and pain has been less studied, alcohol use disorders are also prevalent among chronic pain patients and are of high clinical interest. In both subgroups of patients, failure to alleviate chronic pain contributes to poor clinical and functional outcomes. This review discusses common evaluation and diagnostic dilemmas in treating this challenging population.