This document discusses addiction, pseudo-addiction, and an integrated approach to pain management. It defines pseudo-addiction as medication-seeking behavior that occurs when pain relief is inadequate, and distinguishes it from true addiction by noting that pseudo-addicted individuals do not seek euphoria and focus on treatment, while addicted individuals do. The document advocates for a balanced, multidisciplinary approach addressing physical, cognitive, emotional, social, and spiritual factors to maximize function and quality of life.

1. Addiction, Pseudo-addiction &
An Integrated Approach
Rory Fleming Richardson, Ph.D., ABMP, TEP
Clinical Medical Psychologist & Neuropsychologist
Copyright 2009, Dr Rory Fleming Richardson

2. Function is the benchmark for proper
pain management.
Some of the keys of pain management are
the monitoring of pain, level of relief and
level of function.
Optimally,
• pain level is low, and
• Level of relief and level of function are
high.

3. • Physical
• Gross motor
• Fine motor
• Vestibular sense
• Sensory function and processing
• Sleep and rest
• Nutrition
• Activity level
• Emotional
• Ability to cope with stress and conflict
• Absence of mood disorder
• Absence of psychiatric symptoms
• Playing and leisure activities

4. • Cognitive
• Recall of information
• Short-term memory
• Long-term memory
• Computation
• Application of knowledge
• Comparative analysis
• Choice and judgment
• Interpersonal
• Desire to belong
• Bonding
• Prosody
• Problem-solving
• Working with others
• Adapting to change to respect others
• Listening
• Ability to take a follower role
• Ability to take a leadership role

6. Children (and I) like this one.

7. This scale I have found to be the best
general scale because it also provides
areas of functional interference.

8. Dependence versus Addiction
Addiction to pain and anxiety medications is a
major concern for health care providers. The
term “Pseudo-Addiction” is used when an
individuals behavior may appear to be that of an
addict but, in fact, is not. In some cases, the
level of maintenance medication is not high
enough to provide effective relief from pain. It is
also very common for individuals who are on
a maintenance dosage of pain medication to be
concerned about running out of the medication.
In both cases, medication seeking can occur.

9. The challenge is to use all forms of pain
management to provide the level of relief
necessary for basic daily function and
some quality of life.

10. An individual showing Pseudo-Addiction will:
 not take more medications than is necessary
to relieve the pain and may sometimes take
less,
 not take dosages which result in euphoria,
 not show signs of intoxication.
They will:
 follow recommendations of the physician,
 focus on the potential side effects of the
medication,
 focus on the consequences of the side effects.

11. There are behaviors that are frequently
misunderstood which do not show addiction but
providers are sensitive too raising concerns. The
behaviors which are less likely to be
indicators of addiction are:
 complaining about needing a higher dosage,
 hoarding drugs for periods when symptoms are
increased,
 acquiring similar medications from different
prescribers for different purposes (i.e., a person
on chronic pain medications through their PCP
getting an acute pain relief medication from a
dentist for dental pain).

12. Important Note:
Just because a person is on chronic pain
medications, does not mean that that person does
not need acute pain medication for acute pain
events. The chronic pain medication provides a
foundation and will not cover the acute pain events.
In emergency situations, it is imperative for the
treating physician to know about the chronic pain
management and to consult with the physician
responsible for the pain management. If the patient
knows of medical or dental procedures which are
planned, consult with the pain management
physician to plan for acute pain treatment needs.

13. Individuals who are Addicted will
attempt to achieve euphoria,
increase the amount used beyond a point
of relieving pain,
show signs of intoxication.
They will not:
focus on side effects,
be concerned with consequences of side
effects,
follow physician recommendations.

14. Other addictive behaviors include:
selling prescription medications,
forging prescriptions,
stealing another patient’s drugs,
using the medication in a different way than
recommended (i.e., IV, smoking, etc.)
seeking pain medication from multiple providers,
using different pharmacies for similar
medications without knowledge of the
prescribers,
repeatedly losing their prescription,
buying medications from street dealers,
mixing medications and alcohol to attain a state
of euphoria.

16. • Myoflex
• Cyclobenzaprine
• Valium
• Zanaflex (Tizanidine)
• Natural Relaxers (Passiflora,
Valerian, Chamomile, Licorice,
Lobelia Extract, Calcium/
Magnesium)
• Hydroxyzine

17. • NAISD
• Omega-3
• Aspirin
• Naprosyn
• Naproxen/Aleve
• Ibuprophren/Advil
• Acetaminophen/Tylenol
• Glucosamine - Chondroitin
• Bioflavonoids
• Systemic Enzyme
• Devil’s Claw

18. • Morphine
• Methadone
• Vicodin
• Oxycodone
• Hydrocodone
• OxyContin
• Kadian
• MS Contin
• Lyrica
• Neurontin
• Amitriptyline
• Ultram
• Transdermal Pain Patches
• Natural Pain Killers (Kava Root, White
Willow, Horsetail, Valerian, Cayenne
Pepper)
• Prescribed Medical THC

19. • Craniosacral Massage
• Massage
• Chiropractics
• Acupressure
• Acupuncture
• Stretching
• Yoga
• Occupational Therapy
• Physical Therapies
• Aquatic Therapy
• Traction
• Hot Tub/Spa
• Ultrasound
• TENS Unit
• Moist Heat & Ice Packs

20. • Psychotherapy & Counseling
• Pacing Activities
• Sleep & Sleep Treatment
• Know Your Limitations
• Biofeedback/Neurofeedback
• Nutritional Balance
• Spirituality
• Psychopharmacology
• Support Groups

21. • Hypnosis
• Self-hypnosis
• Transcendental Meditation
• Breathing Exercises (i.e., Hatha
Yoga)
• Relaxation Techniques
• Stress Management
• Tai Chi & Qi Gong
• Enjoyable Activities (distraction)
• Spiritual Exercises & Practices

22. In some cases, surgical intervention may be considered.
These can include devices delivering medicine, electric
current, heat, or chemicals to numb or block pain.
• Intrathecal medications: sends medicine to the area
of your pain.
• Electrical nerve: stimulation uses electric current to
interrupt pain signals.
• Nerve ablation: destroys or removes the nerves that
are sending pain signals.
• Chemical sympathectomy: utilizes chemicals to
destroy nerves.

23. The secret
to proper
pain
managem
ent is
balance.

25. Thank you!
drrory@live.com
www.drrory.net