Substance Use and Related Disorders (JR McKay, Section Editor)

Current Psychiatry Reports

, Volume 14, Issue 5, pp 462-468

First online:

Management of Pain With Comorbid Substance Abuse

  • Daniel KrashinAffiliated withAnesthesiology and Pain Medicine, University of Washington Medical Center Email author 
  • , Natalia MurinovaAffiliated withNeurology, University of Washington Medical Center
  • , Jane BallantyneAffiliated withAnesthesiology and Pain Medicine, University of Washington Medical Center

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Abstract

Substance use disorders are a large public health problem in the United States. Over the past decade, there has been a trend of increased prescription drug misuse, morbidity, and mortality related to prescription opioids. For providers who treat pain, this has led to clinical dilemmas as the newly appreciated risks must be balanced with the benefits of treatment, particularly in patients with known substance use disorders. Acute, chronic, and palliative each present distinct issues in pain treatment. A best practices model of pain treatment, including risk stratification and integrative treatment, may provide the best prospect for safe and effective treatment.

Keywords

Addiction Substance abuse Acute pain Chronic pain Palliative care Cancer pain Aberrant behavior Opioid abuse Opioid addiction Opioid dependence Drug diversion Opioid tolerance Risk management Risk stratification Screening Pain management Urine drug screening Psychological testing Substance abuse treatment