Recommendations for Substance Abuse and Pain Control in Patients with Chronic Pain

  • Nalini Vadivelu
  • Alice M. Kai
  • Gopal Kodumudi
  • Dan Haddad
  • Vijay Kodumudi
  • Niketh Kuruvilla
  • Alan David Kaye
  • Richard D. Urman
Other Pain (A Kaye and N Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


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.

Recent Findings

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.


Substance 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

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Nalini Vadivelu
    • 1
  • Alice M. Kai
    • 2
  • Gopal Kodumudi
    • 3
  • Dan Haddad
    • 1
  • Vijay Kodumudi
    • 4
  • Niketh Kuruvilla
    • 5
  • Alan David Kaye
    • 6
  • Richard D. Urman
    • 7
  1. 1.Yale UniversityNew HavenUSA
  2. 2.Department of Internal MedicineNYU-Winthrop HospitalMineolaUSA
  3. 3.California Northstate School of MedicineElk GroveUSA
  4. 4.University of Connecticut School of MedicineFarmingtonUSA
  5. 5.Department of Anesthesiology, Austin HealthHeidelbergUSA
  6. 6.Department of AnesthesiologyLouisiana State University Health Sciences CenterNew OrleansUSA
  7. 7.Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s HospitalBostonUSA

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