Chronic pain management: Is addiction a risk? Is consultation a necessity?

The medications most often implicated in prescription drug abuse are opioid analgesics, sedative-hypnotics, and stimulants. Because they are exposed to these drugs, patients with acute or chronic pain are at increased risk of addiction comorbidity. It is important to ask patients about their family and substance-use history, including alcohol, illicit drugs, and prescription drugs. Patients who abuse prescription drugs may exhibit certain patterns, such as escalating use, drug-seeking behavior, and doctor shopping. Physicians who purposefully over-prescribe are in the minority; however, sloppy practice or inattention to detail can contribute to the problem of drug seeking. Maintaining a high index of suspicion, documenting the decisions that guide the treatment process, and seeking consultation early are important risk-management strategies that improve clinical care and outcomes in patients treated for chronic pain. This article discusses the implications of treating chronic pain in patients suspected of chemical dependency, optimal ways to achieve pain control, and how to avoid adverse outcomes or descent into addiction. Finally, a review of how supportive measures, such as seeking consultation, individual and group psychotherapy, and Twelve Step participation, can assist the pain management physician is presented.