Recommendations for Substance Abuse and Pain Control in Patients with Chronic Pain
- 435 Downloads
Purpose of Review
In the present investigation, current literature on the relationship between substance abuse and pain is evaluated in order to improve clinical management and its implications on the increasingly challenging chronic pain and substance abuse epidemic. The relationship between substance abuse and chronic pain are evaluated, and this review provides recommendations on the management of this special patient population.
Currently, there are limited guidelines for prescribing opioids and other analgesics in the chronic pain population. As this field of practice continues to evolve, it is essential for clinicians to serve as the gatekeepers to monitor for misuse and safety. Multiple studies have indicated that illicit drug use and opioid abuse affect over 9% of patients. Although there are numerous reasons for seeking illicit drugs and abusing them, it is essential that clinicians identify factors which place certain patients at high risk and accordingly, to screen these patients in order to optimize their management.
The high prevalence of patients with chronic pain who also screen positive for drug use emphasizes the importance and increasingly pressing need to evaluate and to manage chronic pain in this population.
KeywordsSubstance abuse Pain control Chronic pain Opioid Addiction Prescription
Compliance with Ethical Standards
Conflict of Interest
Nalini Vadivelu, Alice M. Kai, Gopal Kodumudi, Dan Haddad, Vijay Kodumudi, Niketh Kuruvilla, Alan David Kaye, and Richard D. Urman declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Gaskin D, Richard P. Relieving pain in America: a blueprint for transforming prevention, care, education, and research Appendix C, The Economic Costs of Pain in the United States. Washington DC: National Academies Press (US); 2011.Google Scholar
- 3.Barry DT, Savant JD, Beitel M, Cutter CJ, Moore BA, Schottenfeld RS, et al. Pain and associated substance use among opioid dependent individuals seeking office-based treatment with buprenorphine–naloxone: a needs assessment study. Am J Addict. 2013;22(3):212–7.PubMedPubMedCentralCrossRefGoogle Scholar
- 14.Weaver M, Schnoll S. Abuse liability in opioid therapy for pain treatment in patients with an addiction history. Clin J Pain. 2001;18(4 Suppl):S61–9.Google Scholar
- 19.Dabu-Bondoc S, Shah AA, Effraim PR. Prescription drug abuse. Subst Abuse: Springer; 2015. 127–41.Google Scholar
- 22.Warner M, Trinidad JP, Bastian BA, Minino AM, Drugs HH. Most frequently involved in drug overdose deaths: United States, 2010-2014. Natl Vital Stat Rep: Cent Dis Control Prev, Nat Cent Health Stat, Natl Vital Stat Syst. 2016;65(10):1–15.Google Scholar
- 28.Vadivelu N, Urman RD, Hines UR. Essentials of Pain Management: Springer: 2011. 671–697.Google Scholar
- 30.Oslin, David W. “Addictions.” Psychiatry for Neurologists. Humana Press, 2006. 93–104.Google Scholar
- 34.Weiss RD, Potter JS, Fiellin DA, Byrne M, Connery HS, Dickinson W, et al. Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: a 2-phase randomized controlled trial. Arch Gen Psychiatry. 2011;68(12):1238–46.PubMedPubMedCentralCrossRefGoogle Scholar
- 48.•• Califf RM, Woodcock J, Ostroff S. A proactive response to prescription opioid abuse. N Engl J Med. 2016;374(15):1480–5. A special report regarding the increasingly pressing importance in assessing the current epidemic and the need for improvements on appropriate opioid use and pain management. PubMedCrossRefGoogle Scholar
- 50.Vital signs: overdoses of prescription opioid pain relievers—United States, 1999--2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487–92.Google Scholar
- 53.•• Kaye AD, Jones MR, Kaye AM, Ripoll JG, Galan V, Beakley BD, et al. Prescription opioid abuse in chronic pain: an updated review of opioid abuse predictors and strategies to curb opioid abuse: part 1. Pain Physician. 2017;20(2s):S93–s109. (excellent review on opioid abuse predictors and strategies for pain physicians). PubMedGoogle Scholar
- 54.•• Kaye AD, Jones MR, Kaye AM, Ripoll JG, Jones DE, Galan V, et al. Prescription opioid abuse in chronic pain: an updated review of opioid abuse predictors and strategies to curb opioid abuse (part 2). Pain Physician. 2017;20(2s):S111–s33. (excellent review on opioid abuse predictors and strategies for pain physicians). PubMedGoogle Scholar
- 59.Paulozzi LJ, Strickler GK, Kreiner PW, Koris CM. Controlled substance prescribing patterns—prescription behavior surveillance system, eight states, 2013. Morb Mortal Wkly Rep Surveill Summ. 2015;64(9):1–14.Google Scholar
- 61.Chou R, Fanciullo GJ, Fine PG, Miaskowski C, Passik SD, Portenoy RK. Opioids for chronic noncancer pain: prediction and identification of aberrant drug-related behaviors: a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain: Off J Am Pain Soc. 2009;10(2):131–46.CrossRefGoogle Scholar
- 65.Potter JS, Marino EN, Hillhouse MP, Nielsen S, Wiest K, Canamar CP, et al. Buprenorphine/naloxone and methadone maintenance treatment outcomes for opioid analgesic, heroin, and combined users: findings from starting treatment with agonist replacement therapies (START). J Stud Alcohol Drugs. 2013;74(4):605–13.PubMedPubMedCentralCrossRefGoogle Scholar
- 71.Nunberg H, Kilmer B, Pacula RL, Burgdorf J. An analysis of applicants presenting to a medical marijuana specialty practice in California. J Drug Policy Anal. 2011;4(1).Google Scholar