Current Pain and Headache Reports

, Volume 15, Issue 2, pp 91–93

Maladaptive Opioid Use Behaviors and Psychiatric Illness: What Should We Do with What We Know?

Invited Commentary

DOI: 10.1007/s11916-011-0177-3

Cite this article as:
Carroll, C.P. & Haythornthwaite, J. Curr Pain Headache Rep (2011) 15: 91. doi:10.1007/s11916-011-0177-3


It is well established that opioids are broadly effective for chronic pain. Although there is some agreement that stable, moderate dosing is desirable; longer-term management of patients with chronic pain often confronts clinicians with difficult decisions regarding when to intensify opioid treatment and when to declare failure. Under these circumstances the concern for addiction arises with uncomfortable frequency in specialty settings. An emerging literature has defined a number of plausible markers of risk for aberrant opioid use behaviors in clinical chronic pain populations. Some of these risk factors involve the presence of comorbid psychiatric illnesses, which puts clinicians in the difficult position of deciding whether or not to limit treatment to patients who are more complex. The authors discuss the issues of bad behavioral outcomes in opioid therapy, the implications of this emerging literature for clinicians, and suggest broad areas in which researchers can improve the knowledge base with which clinicians operate.


Chronic painOpioid therapyMajor depressive disorderBipolar disorderSubstance dependence

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesThe Johns Hopkins University School of MedicineBaltimoreUSA