Optimizing treatment with opioids and beyond

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Patients with both chronic pain and substance use disorders offer special challenges and opportunities. They represent a large number of patients with significant costs to themselves and society that translate into poor outcome. The challenges in defining addiction in patients with chronic pain, particularly in those treated with chronic opioid therapy, have distracted the healthcare community from designing effective treatment programs. Traditional treatment programs for chronic pain disorders or substance use disorders are incapable of addressing the issues of the patients' 'other' problem. Treatment devolves to prescribing opioid medications with the belief that both disorders will be treated at least in part, which is deemed better than receiving no treatment at all. Patients are actually concerned about the risks of this type of treatment, and even if it did offer significant benefits, physicians demonstrate a lack of knowledge and skill in administering opioids to these patients. The inadequate treatment of either chronic pain or addiction interferes with the treatment of the other condition and necessitates the design of new treatment paradigms. A new approach to patients with both chronic pain and addiction should start with an evaluation and formulation of these patients to determine the different domains that contribute to their disability (diseases, dimensions, behaviors, life stories). A comprehensive formulation provides the appropriate platform for the implementation of an integrated program of therapy for both conditions that can be intensified to provide more, rather than less, care for the patient that does not meet the goals of functional rehabilitation.

Original languageEnglish (US)
Title of host publicationChronic Pain and Addiction
EditorsM.R. Clark, G.J. Treisman
Pages92-112
Number of pages21
DOIs
StatePublished - Apr 1 2011

Publication series

NameAdvances in Psychosomatic Medicine
Volume30
ISSN (Print)0065-3268

ASJC Scopus subject areas

  • Psychiatry and Mental health

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