Co-Managing Chronic Pain and Addictive Disorders

John A. Bailey, M.D.
Assistant professor
Depts of Psychiatry and Anesthesiology
Division of Addiction Medicine and Pain Management
Program Director, Pain Medicine
Springhill Health Center
University of Florida
Gainesville, Florida

Robert W. Hurley, M.D., Ph.D.
Associate professor
Depts Anesthesiology, Psychiatry, Neurology
Chief of Pain Medicine at UF
Fellowship Director
University of Florida
Gainesville, Florida

Mark S. Gold, M.D.
Department Chairman
Donald R Dizney Eminent Scholar and Distinguished Professor
Psychiatry
University of Florida
Gainesville, Florida

Introduction - TOP

Despite the high comorbidity of addictive disorders and chronic pain, little attention is devoted to recognizing and managing addictive disorders in most pain medicine fellowship programs.1 The degree of the coexistence of these two disorders is striking. For example, 37% of patients in methadone maintenance and 24% of inpatients in drug treatment complain of severe chronic pain, and conversely, 2.8-50% of chronic pain patients suffer from addictive disorders, depending on the study and the definition of addiction used.2,3

Recognizing and treating patients with coexisting addiction and chronic pain is challenging since addiction usually results in deception. Since pain is subjective and can exist without physical findings, we are forced to rely heavily on what our patient’s tell us. Addiction short circuits and hijacks the brain resulting in deception towards caregivers, as well as unconscious self deception (denial). Research has shown that physicians are not adept at spotting deception.4 Adding to the challenge is evidence that many patients with addictive disorders have a “syndrome of pain facilitation” with anxiety, depression, sleep disturbance, and decreased pain tolerance.5,6 The number of problems to co-manage in this patient population can seem overwhelming.

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