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S. Karger AG

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182 pages

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Patients with chronic pain understandably seek relief from their distress and discomfort, but many medications that alleviate pain are potentially addictive, and most chronic pain conditions only have a temporary response to opiate analgesic drugs. This volume reviews the fundamental topics that underlie the complex relationships of this controversial domain. The authors review behavioral models and practical methods for understanding and treating chronic pain and addiction including methods to formulate patients with complex comorbidity and screen patients with chronic pain for addictive liability. Finally, the authors describe the current findings from clinical and basic science that illuminate the role of opiates, cannabinoids and ketamine in the treatment of chronic pain. Up to date and comprehensive, this book is relevant to all professionals engaged in the care of patients with chronic pain or addiction and all others interested in these contemporary issues, particularly non-clinicians seeking clarity in the controversy over the best approach to patients with chronic pain.

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Publié par	S. Karger AG
Date de parution	20 avril 2011
Nombre de lectures	0
EAN13	9783805597265
Langue	English
Poids de l'ouvrage	1 Mo

Informations légales : prix de location à la page 0,0170€. Cette information est donnée uniquement à titre indicatif conformément à la législation en vigueur.

Extrait

Chronic Pain and Addiction
Advances in Psychosomatic Medicine
Vol. 30
Series Editor
T.N. Wise Falls Church, Va.
Editors
G.A. Fava Bologna
I. Fukunishi Tokyo
M.B. Rosenthal Cleveland, Ohio
Chronic Pain and Addiction

Volume Editors
M.R. Clark Baltimore, Md.
G.J. Treisman Baltimore, Md.
10 figures and 14 tables, 2011

Basel • Freiburg • Paris • London • New York • Bangalore • Bangkok • Shanghai • Singapore • Tokyo • Sydney
Advances in Psychosomatic Medicine
Founded 1960 by F. Deutsch (Cambridge, Mass.) A. Jores (Hamburg) B. Stockvis (Leiden)
Continued 1972-1982 by F. Reichsman (Brooklyn, N.Y.)
Library of Congress Cataloging-in-Publication Data
Chronic pain and addiction / volume editors, M.R. Clark, G.J. Treisman. p.; cm. -- (Advances in psychosomatic medicine, ISSN 0065-3268; v. 30) Includes bibliographical references and index. ISBN 978-3-8055-9725-8 (hard cover: alk. paper) -- ISBN 978-3-8055-9726-5 (e-ISBN) 1. Chronic pain--Treatment--Complications. 2. Analgesics--Effectiveness. I. Clark, M. R. (Michael R.) II. Treisman, Glenn J., 1956- III. Series: Advances in psychosomatic medicine; v. 30. 0065-3268 [DNLM: 1. Chronic Disease. 2. Pain--drug therapy. 3. Analgesics -- therapeutic use. 4. Opioid-Related Disorders--etiology. 5. Substance-Related Disorders--complications. 6. Substance-Related Disorders--etiology. W1 AD81 v.30 2011 / WL 704] RB127.C4824 2011 616 .0472 -- dc22
2011006954

Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents® and Index Medicus.
Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2011 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN 0065-3268 ISBN 978-3-8055-9725-8 e-ISBN 978-3-8055-9726-5

Contents

From Stigmatized Neglect to Active Engagement
Clark, M.R.; Treisman, G.J. (Baltimore, Md.)
A Behaviorist Perspective
Treisman, G.J.; Clark, M.R. (Baltimore, Md.)
Addiction and Brain Reward and Antireward Pathways
Gardner, E.L. (Baltimore, Md.)
Opioid Therapy in Patients with Chronic Noncancer Pain: Diagnostic and Clinical Challenges
Cheatle, M.D.; O’Brien, C.P. (Philadelphia, Pa.)
Optimizing Treatment with Opioids and Beyond
Clark, M.R.; Treisman, G.J. (Baltimore, Md.)
Screening for Abuse Risk in Pain Patients
Bohn, T.M.; Levy, L.B.; Celin, S.; Starr, T.D.; Passik, S.D. (New York, N.Y.)
Cannabinoids for Pain Management
Thaler, A.; Gupta, A. (Philadelphia, Pa.); Cohen, S.P. (Baltimore, Md./Washington, D.C.)
Ketamine in Pain Management
Cohen, S.P. (Baltimore, Md./Washington, D.C.); Liao, W. (Baltimore, Md.); Gupta, A. (Philadelphia, Pa.); Plunkett, A. (Washington, D.C.)
Subject Index
Clark MR, Treisman GJ (eds): Chronic Pain and Addiction. Adv Psychosom Med. Basel, Karger, 2011, vol 30, pp 1-7
____________________________
From Stigmatized Neglect to Active Engagement
Michael R. Clark a , c • Glenn J. Treisman a-d
Departments of a Psychiatry and Behavioral Sciences and b Medicine, The Johns Hopkins University School of Medicine, and c Chronic Pain Treatment Program and d AIDS Psychiatry Service, The Johns Hopkins Medical Institutions, Baltimore, Md., USA
____________________________
Abstract
Chronic pain and substance abuse are common problems. Each entity represents a significant and independent burden to the patients affected by them, the healthcare system caring for them, and society at large supporting them. If the two problems occur together, all of these burdens and their consequences are magnified. Traditional treatments fail a substantial percentage of even the most straightforward cases. Clearly, new approaches are required for the most complex of cases. Success is possible only if multiple disciplines provide integrated care that incorporates all of the principles of substance abuse and chronic pain rehabilitation treatment into one package. While experience provides the foundation for implementing these programs, research that documents the methods behind successful outcomes will be needed to sustain support for them.
Copyright 2011 S. Karger AG, Basel
Chronic pain and substance abuse are independently recognized as complex problems growing in both scope and severity. Each has its own unique difficulties that contribute to poor outcomes and partial response to treatment. Unfortunately a substantial number of patients suffer from both of these devastating problems. These patients represent a highly stigmatized and uniquely underserved population that would easily benefit from clinical and research enterprises. Practical and longitudinal expertise is needed for the assessment, formulation and treatment of patients who suffer with chronic pain and substance dependence disorder. Identifying opportunities and directions for translational research are important elements in advancing our understanding of these problems and their critically important interrelationships.
In this volume, we have compiled papers related to the topic of chronic pain and addiction. The epidemic increase in the use of prescription opiates and the increasing use of opiates for the purpose of euphoria has led to great concern. There has been an epidemic increase in prescription opiate addiction as well as a dramatic upsurge in opiate use by adolescents. The increased appreciation of the large number of patients who suffer from chronic pain that diminishes their function is one of the drivers of the increased use of opiates. Unfortunately, many of the medications that are effective at reducing pain are reinforcing and create the potential for addiction.
Refractory Chronic Pain Does Not Equal Addiction
Patients with a poor response to typical treatments for chronic pain are at increased risk of being labeled a ‘drug addict’ when they request more aggressive pain therapy. Whether they specifically ask for opioid analgesics or not, practitioners will often assume the worst. In patients with known substance use disorder, continuing complaints of pain are routinely regarded simply as drug-seeking behavior that is undermining or counterproductive for their ‘recovery’ plan. The usual approach to evaluating this complex set of problems devolves to determining whether the patient has a ‘real pain problem or is simply an ‘addict’. This dichotomy ends in unsophisticated diagnoses and cookie-cutter treatments.
In contrast, patients with unquestionable chronic pain can and do develop independent substance use disorders that emerge despite the most sincere efforts to seek understandable relief from their pain. Once again, the rush to judgment reflected in the evaluation phase of this problem can lead to the emphasis on only one dimension of the presentation (e.g. substance abuse or pain), which minimizes the other dimension (pain or substance abuse). An essential element in the successful treatment of these patients that present with features of both problems is tolerating the ambiguity that can dominate the initial evaluation and accepting that the question can be resolved with sufficient time in active treatment.
Enhancing Treatment with Integrated Approaches
The common interactions between chronic pain, opioids, and other medical and psychiatric problems including substance use disorders makes treatment-seeking, opioid-dependent patients a critically important subgroup of patients with a compelling need for enhanced evaluation and treatment services [ 1-3 ]. Regrettably, patients with chronic pain combined with substance use disorder (especially opioid dependence) remain a stigmatized, maligned and often neglected population [ 4 - 6 ]. Our inability to transmit the public health needs to the individual patient increases the risk for drug-seeking behavior, including self-medication with illicit drugs and the serious hazards associated with this practice.
While the benefits of substance abuse treatment are widely touted,