Pain: Substance Abuse Issues in the Treatment of Pain
About 50 million Americans suffer from chronic pain . As our population continues to age, this number is likely to grow, yet unfortunately, pain continues to be undertreated and poorly treated. Forty to 60% of people with severe pain in the context of life-limiting illnesses have difficulty getting their pain adequately treated [2, 3, 4]. Lost productive time and cost due to common pain conditions in the United States affects 13% of the total workforce and costs the nation $61.2 billion per year .
Millions of persons with pain from chronic diseases such as arthritis, diabetes, headaches, and muscle disorders suffer and have difficulty finding and paying for qualified professionals willing to help them gain access to the medicines, physical and psychological therapies and surgical/anesthetic interventions that can help them lead higher quality and more productive lives.
Chronic pain serves no useful purpose  once the underlying cause has been identified. It is no longer a...
KeywordsHigh Performance Liquid Chromatography Pain Management Pain Patient Control Substance Chronic Pain Patient
- 7.Morgan JP. American opiophobia: customary underutilization of opioid analgesics. Advances in Alcohol & Substance Abuse, 1985, 5:163–73.Google Scholar
- 8.Pohl M. Pain. In Special Populations. 3rd ed. Principles of Addiction Medicine, Graham A et al, editors,Chevy Chase MD, American Society of Addiction Medicine, 2003.Google Scholar
- 9.Glajchen, M, Chronic pain: treatment barriers and strategies for clinical practice. Journal of American Board of Family Practice, 2001, 14(3):211–8.Google Scholar
- 11.Acute Pain Management Guideline Panel. Acute Pain Management: Operative or Medical Procedures and Trauma; Clinical Practice Guideline. AHCPR Publication Number 92-0032, Rockville MD, Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, 1992.Google Scholar
- 12.Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain. Clinical Practice Guideline. AHCPR Publication Number 94-0592, Rockville MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, 1994.Google Scholar
- 15.Wassan AD, Correll DJ, Kissin I, O’Shea S, Jamison RN. Iatrogengenic addiction inpatients treated for acute or subacute pain. Journal of Opioid Management, 2006, 2(1): Jan./Feb.:16–21Google Scholar
- 17.Compton, P. and G. Gebhart, The Neurophysiology of Pain and Interfaces with Addiction, in Principles of Addiction Medicine, A. Graham, et al., Editors. 2003, American Society of Addiction Medicine: Chevy Chase, MD. pp. 1385–1404.Google Scholar
- 19.Heit HA. Addiction, physical dependence, and tolerance: precise definitions to help clinicians evaluate and treat chronic pain patients. Journal of Pain & Palliative Care Pharmacotherapy, 2003, 17(1):15–29.Google Scholar
- 20.Battin MP, Luna E, Lipman AG et al. Drugs and Justice: Seeking a Consistent, Coherent, Comprehensive View. NY, Oxford University Press, 2007.Google Scholar
- 21.Heit HA, Gourlay D. Chronic Pain and Addiction. In Chronic Abdominal and Visceral Pain: Theory and Practice. Pasricha PJ, Willis WD, Gebhart GF, editors, NY. Taylor and Francis, 2006.Google Scholar
- 23.American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine. Definitions Related to the Use of Opioids for the Treatment of Pain, Glenview, IL, American Academy of Pain Medicine, 2001.Google Scholar
- 27.Lipman AG, Jackson KC. Opioids. In Warfield C, Bajwa Z, editors, Principles and Practice of Pain Management, 2nd edition, New York, McGraw Hill, 2003.Google Scholar
- 28.Fakata KL, Lipman AG. Opioid Bowel Dysfunction in Acute and Chronic Non-malignant Pain. In Yuan S-H, editor, Opioid Bowel Dysfunction, Binghamton NY, Haworth Medical Press, 2004.Google Scholar
- 29.Diagnostic and Statistical Manual of Mental Disorders – Text Revised, 4th edition, Washington DC, American Psychiatric Association, 2000.Google Scholar
- 31.Gourlay D, Heit HA, Caplan YH. Urine Drug Testing in Primary Care: Dispelling the Myths & Designing Strategies. San Francisco, California Academy of Family Physicians, 2006.Google Scholar
- 34.Conigliaro C, Reyes CR, Schultz JS. Principles of screening and early intervention. In: Graham AW, Schultz TK, Mayo-Smith M, Ries RK, Wilford BB, eds. Principles of addiction medicine, third edition. Chevy Chase, MD: American Society of Addiction Medicine, 2003, 323–1Google Scholar
- 40.Shults TF, St. Clair, S. The Medical Review Officer Handbook. 7th ed. Research Triangle Park NC. Quadrangle Research, 1999.Google Scholar
- 41.MROALERT November 6 Vol. XVII; No. 9(1–4)Google Scholar
- 42.American Academy of Pain Management, American Pain Society. The use of opioids for the treatment of chronic pain. Consensus Statement, 1996. www.ampainsoc.org.
- 44.Heit HA. Creating and Implementing Opioid Agreements. Disease Management Digest, 2003, 7(1):2–3, in: Care Management, 2003, 9Google Scholar
- 45.Passik SD, Heit HA, Kirsh KL. Reality and Responsibility: A Commentary on the Treatment of Pain and Suffering in a Drug-Using Society. Journa of Opioid Management, 2006, 2(3):1–5.Google Scholar