Psychogenic Pain : Psychosomatic Point of ViewAndri Andri
This presentation was presented in "Medical Approach in Holistic Management to Relieve Pain" 13 Des 2015 at The Sunan Hotel, SOLO.
Since Pain is always subjective, Psychogenic pain is very related to psychiatric problems and very often it does not recognized by physicians in their practice.
Psychogenic Pain : Psychosomatic Point of ViewAndri Andri
This presentation was presented in "Medical Approach in Holistic Management to Relieve Pain" 13 Des 2015 at The Sunan Hotel, SOLO.
Since Pain is always subjective, Psychogenic pain is very related to psychiatric problems and very often it does not recognized by physicians in their practice.
The workshop is designed to increase knowledge of cognitive behavioural therapy (CBT) and relapse prevention (RP) strategies and resources in, treatment and proper
management of alcohol and drug addiction treatment and
aftercare.
A D D I C T I O N : A chronic, neurobiologic disease characterized by impaired control over drug use, compulsive use,
continued use despite harm, and cravings.
D E P E N D E N C E : A psychological craving for, habituation to, abuse of, or physiologic reliance on a chemical
substance .
T O L E R A N C E : A need for a markedly increased amounts of substance to achieve intoxication or desired effect. W I T H D R A W : Substance specific syndrome that occur after stopping or reducing the amount of substance over a
prolonged period of time
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502.
Presentation by Erin E. Krebs, MD, MPH, Minneapolis VA Health Care System and University of Minnesota Medical School
Drug addiction is complex illness characterized by compulsive and uncontrollable drug
craving, seeking and use that persists even in the face of extremely negative
consequences. Drug abuse and its disorders are the result of complex interaction of
sociological, biological and physiological factors. With the easy availability of semi-
synthetic products like heroin the abuse can be associated with more than one factors.
Tolerance means diminishing effect of the same dose of a drug or the need
to increase the dose to get a similar effect.
Habituation is the emotional or psychological need felt for a drug.
Dependence is the physical need to take the drug.
According to ICD 10 & DSM 5 , 12 categories of substances have been listed here alongwith their signs ,symptoms .
terminologies related to susbstance use ,their etiology ,management .
The workshop is designed to increase knowledge of cognitive behavioural therapy (CBT) and relapse prevention (RP) strategies and resources in, treatment and proper
management of alcohol and drug addiction treatment and
aftercare.
A D D I C T I O N : A chronic, neurobiologic disease characterized by impaired control over drug use, compulsive use,
continued use despite harm, and cravings.
D E P E N D E N C E : A psychological craving for, habituation to, abuse of, or physiologic reliance on a chemical
substance .
T O L E R A N C E : A need for a markedly increased amounts of substance to achieve intoxication or desired effect. W I T H D R A W : Substance specific syndrome that occur after stopping or reducing the amount of substance over a
prolonged period of time
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502.
Presentation by Erin E. Krebs, MD, MPH, Minneapolis VA Health Care System and University of Minnesota Medical School
Drug addiction is complex illness characterized by compulsive and uncontrollable drug
craving, seeking and use that persists even in the face of extremely negative
consequences. Drug abuse and its disorders are the result of complex interaction of
sociological, biological and physiological factors. With the easy availability of semi-
synthetic products like heroin the abuse can be associated with more than one factors.
Tolerance means diminishing effect of the same dose of a drug or the need
to increase the dose to get a similar effect.
Habituation is the emotional or psychological need felt for a drug.
Dependence is the physical need to take the drug.
According to ICD 10 & DSM 5 , 12 categories of substances have been listed here alongwith their signs ,symptoms .
terminologies related to susbstance use ,their etiology ,management .
Wsam Presentation For Opiate GuidelinesJKRotchford
CME presentation at WSMA annual meeting. Problematic opioid use, questioning the concept of "pseudo-addiction", seeing chemical dependency as somewhere well along the continuum of problematic opioid use.
Diagnosis and Treatment of Psychosomatic Disorder (Educational Slides)Andri Andri
This is a standard presentation for teaching medical students and colleagues about psychosomatic disorder, its diagnosis and therapy. We hope by reading this slides, you will understand the nature of psychosomatic disorder and its current approach in therapy
substance use , Treatment for substance abuse often involves a combination of...arunjms86
Substance abuse can involve the misuse of legal substances, such as alcohol or prescription medications, as well as the use of illegal drugs. Some common substances of abuse include alcohol, nicotine, marijuana, cocaine, opioids (such as heroin and prescription painkillers), methamphetamines, and hallucinogens.
For this Discussion, review the case Learning Resources and the DustiBuckner14
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 1 En
Three questions to ask the patient and a rationale for asking these questions.
How may I be of assistance today? This question creates a rapport between you and the patients, and it makes her know that the doctor is ready to listen and help her.
What are you doing to cope with grief after losing your husband? This question will help the care ...
Psychopharmacology is a field of study that explores the effects of drugs and medications on the human mind, behavior, and emotions. It delves into the interactions between chemicals (pharmacology) and mental processes (psychology). This interdisciplinary science focuses on understanding how various drugs, including prescription medications, affect the brain's neurochemistry and, consequently, influence a person's thoughts, feelings, and behaviors. this ppt contains introductory portion of psychopharmacology
Understanding Narcotic Medications for Service Membersmilfamln
Narcotic medications may be prescribed for a variety of treatments, primarily pain management, anxiety, and sleep disorders. With conditions such as chronic pain, another treatment or prescription may be given with narcotic prescriptions to augment and extend the effect of these medications.
In the presentation military professionals will learn about various classes of narcotics, along with their actions, interactions with other medications, and the potential dependence it may cause for wounded warriors. The presentation will also highlight differences in the therapies for acute and chronic pain management, as well as posttraumatic stress disorder (PTSD). The important role of military professionals, who work with the service member and families, to understand medication management will also be explored.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
3. Mrs S is a 65 yr old with failed back syndrome on high dose
fentanyl patch. She presents to the Pain Clinic in much
distress. Her husband is with her and is also distressed. She
is leaning over the exam table throughout the consultation,
and grimacing throughout. She can hardly speak she is in so
much pain, so her husband fills in.
We decide to convert her to methadone on the basis that
she may have developed tolerance to fentanyl. Initially she
does well on methadone, pain is greatly improved and they
are both happier.
4. She returns to the Clinic (early), again in great pain distress. The
story is that she has been vomiting up the methadone and is not
getting any pain relief. She has run out of methadone 2 weeks
early. Her husband is in tears stating it is all his fault because he
gave her too much, and he can’t bear to see her suffering. After
controlling her pain with IV ketorolac, we discuss options (at
length) and eventually agree to try methadone suppositories. The
clinic pharmacist arranges for a compounding pharmacy near their
home to make up the suppositories. However, they leave in a
hurry stating that they need help immediately and will go to the
emergency room.
7. Substance abuse
Maladaptive drug seeking that does not meet criteria for “substance dependence”,
in part because of lack of tolerance and physical dependence
Substance dependence (“drug addiction”)
Maladaptive drug seeking together with tolerance and dependence
Concept of layers of substance use disorder now abandoned
Use of the word “dependence” to mean addiction now abandoned
DSM III and IV
11. Before 1950s
• Addiction considered a weakness of character or control, not
a medical illness
• Understanding of addiction neurobiology was rudimentary
• Existence of endogenous opioid system only imagined
12. 1950s
• First DSM (1952) grouped alcohol and substance abuse
under Sociopathic Personality Disturbances
• Did not recognize the key role of tolerance and withdrawal
in drug addiction
• “Reward” center in the brain first recognized
• Addiction began to be understood as essentially a
compulsive and pathological pursuance of natural
“rewards”
13. 1970s
• Discovery of opioid receptors, although addiction
researchers had surmised the existence of the receptor
types (μ, κ, δ and σ) earlier, and on the basis of
pharmacological studies
• Discovery of endogenous opioids
Pert and Snyder Science 1973;179:1011-4
Hughes et al Nature 1975;258:577-80
14. 1980s
• DSM-III tolerance and withdrawal included as addiction
criteria together with social and cultural factors
• Term “dependence” first used to denote drug addiction
• “Dependence” is distinguished from “abuse” which is
considered a precursor to dependence or addiction
16. The brain on opioids
The brain that is exposed to opioids is different from the brain
that is not exposed.
Nestler Neuron 1996;16:897
Nestler Neuropharmac 2004:47 Suppl 1:24
Cami & Farre NEJM 2003;349:975
17. Positive reinforcing effects
• mesocorticolimbic dopamine systems
• “reward circuits”
• cause euphoria and reinforcement of drug-
seeking behaviors
18. Negative reinforcing effects
• withdrawal anhedonia (same system) during early
withdrawal
• physical effects of withdrawal arising from physical
dependence (upregulation of cAMP in locus ceruleus
and other locations)
NOTE: Both are significant driving force in drug-seeking behavior, but must be
distinguished from long-term drug craving which persists long after
recovery from withdrawal
19. Stress and contextual clues
• Conditioning, powerful memory input
• Not easy to eradicate, even after drug cessation
• More incessant stimulation less easy to eradicate
• Structures involved are those involved in memory,
conditioning and learning: amygdala, hippocampus,
prefrontal cortex and thalamus
20. Enduring adaptations
• Explain relapse
• Result of complex interactions between drugs themselves and
the circumstances under which they are taken
• Neuroadaptation occurs through gene regulation, remodeling
of circuits, changes in intrinsic excitability, increased in
synaptic strength, actual morphological changes
• These adaptations may also alter analgesia and tolerance
21. Cami, J. et al. N Engl J Med
2003;349:975-986
Metabotropic
Mechanisms of Action
of Drugs of Abuse
23. What’s new about DSM V?
• No longer using the word “dependence”
• Abandoned the concept of a progression from abuse to
dependence
• Because tolerance and dependence do not count as criteria for
drug addiction when an addictive drug is being used medically,
two (instead of one) behavioral criteria are needed
• It will therefore be more difficult to make a diagnosis of addiction
in a patient receiving medical treatment
26. GRAY ZONE
ADDICTED NOT ADDICTED
Meets DSM criteria
for addiction
• No lost prescriptions
• No ER visits
• No early prescriptions
• No requests for dose
escalation
• No UDT aberrancies
• No doctor shopping
(PMP)
27. DSM V Behavioral criteria for Substance Use Disorder
A maladaptive pattern of substance use leading to clinically significant impairment
or distress as manifested by 2 or more of the following:
• Failure to fulfill major role obligations at work, school or home
• Continue in situations in which it is physically hazardous (eg driving)
• Persistent or recurrent social or interpersonal problems
• Substance taken in larger amounts or longer than was intended
• Persistent desire or unsuccessful efforts to cut down
• Great deal of time spent in activities necessary to obtain substance, use substance or
recover from substance use
• Important social, occupations or recreational activities given up or reduced
• Continued use despite knowledge of harm
• Craving
28. Physical – regions of control of somatic function - locus
ceruleus (noradrenergic nucleus)
upregulation of cAMP arousal, agitation, diarrhea, rhinorrhea,
piloerection
Emotional/psychological – reward centers
hedonia anhedonia
Pain pathways
analgesia hyperalgesia
Ballantyne & LaForge, Pain 2007;129:235
Ballantyne et al, Arch Int Med 2012;172:1342
Dependence is inevitable with continuous use
29. Drivers of opioid seeking:
Memory, including memory of pain, pain relief and euphoria
Pain, including withdrawal hyperalgesia, which may be subtle
Withdrawal anhedonia
Physical symptoms of withdrawal which may be subtle
Addiction (craving, compulsive use)
Koob et al, Trends Neurosci 1992;15:186
Nestler & Aghajanian, Science 1997;278:58
Hyman et al, Ann Rev Neurosci 2006;29:565
Dependence drives opioid seeking but is not necessarily addiction
30. • Tolerance is the need to increase dose to
achieve the same effect
• Tolerance may develop for both the euphoric
and analgesic effects of opioids
• Tolerance can be produced by both
psychological (associative) and pharmacological
(non-associative) factors
Ballantyne & LaForge Pain 2007;129:235
33. • Pain and mood are interdependent whether opioid treated or
not
• Pain patients taking opioids continuously develop tolerance and
dependence
• For them, psychosocial stressors not only increase pain, as in
non-treated patients, but also increase tolerance
• Doses are increased to avoid withdrawal and worsening pain
• Ultimately leads to the patient for whom no dose is enough
35. Enduring adaptations produced by established behaviors
For the illicit drug user:
• Procurement behaviors
For the pain patient – much more complex:
• Continuous opioid therapy may prevent opioid seeking
• Memory of pain, pain relief and possibly also euphoria
• Even if the opioid seeking appears as seeking pain relief, it
becomes an adaptation that is difficult to reverse
• It is hard to distinguish between drug seeking and relief
seeking
36. The dependent/addicted pain patient
Not generally recognized as addiction
• Periodic requests for dose escalation
• Refusal to try other treatments, claim of allergies
• High pain score despite opioid
• Not working/on disability
• Anger
Generally recognized as addiction
• Doctor shopping (PMP)
• Aberrant UDT
• Frequent lost prescriptions
37. Summary points
• Patients who stay on opioid pain treatment long-term and
continuously will inevitably develop dependence
• Dependence is not simply physical, nor is it easily reversed
• Distinguishing dependence from addiction is not easy in the
setting of pain treatment with opioids
• Addiction is still not fully understood
• Since the treatment is similar, it may be better to avoid labels, or
create a new label for dependency on prescription analgesics