Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

CHAPTER 17Pain and AddictionRUSSELL K. PORTENOYDAVID LUSSIERKENNETH L. KIRSHSTEVEN D. PASSIKThe complex issues at the interface between pain management and chemicaldependence have received increasing attention during the past decade. Themost intense focus from the clinical perspective has been on the evolving rolefor opioid therapy. In an interesting paradox, specialists in addiction usuallyfocus on the role of these drugs as a major cause of abuse, whereas pain specialistsfocus on their role as essential medications for pain and suffering. Althougheach discipline, of course, is aware of the problems addressed by the other, theantithetical nature of these perspectives historically has supported a lack ofcommunication between these two groups.Given the extraordinary prevalence and interactions between pain andchemical dependence, this lack of communication must be challenged. Bothchronic pain and substance abuse are highly prevalent problems. Numerous surveys,both domestic and international, have recorded a prevalence rate forchronic pain that is as high as 40% (Verhaak, Kerssens, Dekker, Sorbi, &Bensing, 1998). Suveys of substance abuse in the United States have indicatedthat 6–10% of the population regularly use illicit drugs, and approximately 33%have sampled one of these drugs at least once (Colliver & Kopstein, 1991;Groerer & Brodsky, 1992; Regier et al., 1984). It is inevitable that cliniciansencounter patients with pain who abuse drugs, and the need to address issuesthat relate to both pain and drug abuse occurs commonly.367