Current Pain and Headache Reports

, Volume 8, Issue 4, pp 289–294

Assessing aberrant drug-taking behaviors in the patient with chronic pain

  • Steven D. Passik
  • Kenneth L. Kirsh


Tremendous progress has been made in the study and treatment of pain in the past two decades. The growing problem of prescription drug abuse has forced the field to take a new look at opioid prescribing and to seek balance between its risks and benefits. Every pain clinician must become better acquainted with the principles of addiction medicine as they apply to pain management. The assessment of aberrant behaviors in patients with chronic pain is one key aspect of mastering these principles.


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References and Recommended Reading

  1. 1.
    Berry PH, Dahl JL: The new JCAHO pain standards: implications for pain management nurses. Pain Manag Nurs 2000, 1:3–12.PubMedCrossRefGoogle Scholar
  2. 2.
    SUPPORT Study Principal Investigators: A controlled trial to improve care for seriously ill hospitalized patients: a study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT). JAMA 1995, 274:1591.CrossRefGoogle Scholar
  3. 3.
    Osterweis M, Kleinman A, Mechanic D: Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives [Report of the Committee on Pain, Disability, and Chronic Illness Behavior, Institute of Medicine, National Academy of Sciences]. Washington, DC: National Academy Press: 1987.Google Scholar
  4. 4.
    Verhaak PF, Kerssens JJ, Dekker J, et al.: Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain 1998, 77:231–239.PubMedCrossRefGoogle Scholar
  5. 5.
    Porter J, Jick H: Addiction rare in patients treated with narcotics. N Engl J Med 1980, 302:123.PubMedGoogle Scholar
  6. 6.
    Lee LE Jr: Medications in the control of pain in terminal cancer, with reference to the study of newer synthetic analgesics. JAMA 1941, 116:217.Google Scholar
  7. 7.
    Joranson D, Ryan K, Gilson A, Dahl J: Trends in Medicaid use and abuse of opioid analgesics. JAMA 2000, 283:1710–1714.PubMedCrossRefGoogle Scholar
  8. 8.
    Hancock CM: OxyContin use and abuse. Clin J Oncol Nurs 2002, 6:109–110.PubMedGoogle Scholar
  9. 9.
    Colliver JD, Kopstein AN: Trends in cocaine abuse reflected in emergency room episodes reported to DAWN. Public Health Rep 1991, 106:59–68.PubMedGoogle Scholar
  10. 10.
    Gfroerer J, Brodsky M: The incidence of illicit drug use in the United States, 1962–1989. Br J Addict 1992, 87:1345–1351.PubMedCrossRefGoogle Scholar
  11. 11.
    Regier DA, Meyers JK, Dramer M: The NIMH epidemiologic catchment area program. Arch Gen Psychiatry 1984, 41:934–941. This article is important because it highlights the trends in the use of opioids for non-medical purposes.PubMedGoogle Scholar
  12. 12.
    Hays L, Kirsh KL, Passik SD: Seeking drug treatment for oxycontin abuse: a chart review of consecutive admissions to a substance abuse treatment facility in the bluegrass region of Kentucky. J Nal Compr Can Network, 2003, 1(3):423–428. This article outlines the abuse patterns and characteristics of users in Kentucky during the height of the OxyContin abuse phenomenon.Google Scholar
  13. 13.
    Passik SD, Kirsh KL, Hays L, Crown L: An investigation of the use and abuse of prescription opioids among substance abusers seeking admission to a drug and alcohol rehabilitation program. In preparation.Google Scholar
  14. 14.
    Clark JD: Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage 2002, 23:131–137.PubMedCrossRefGoogle Scholar
  15. 15.
    Federation of State Medical Boards: Model guidelines for the use of controlled substances for the treatment of pain. House of Delegates of the Federation of State Medical Boards of the United States, April 1998. Accessed March 2004.Google Scholar
  16. 16.
    Passik SD, Weinreb HJ: Managing chronic nonmalignant pain: overcoming obstacles to the use of opioids. Adv Ther 2000, 17:70–80.PubMedGoogle Scholar
  17. 17.
    Passik SD, Kirsh KL, Whitcomb LA, et al.: A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther 2004, 26:552–561. This article describes the development of a toll to assess multiple domains of outcome in chronic opioid therapy.PubMedCrossRefGoogle Scholar
  18. 18.
    Portenoy RK: Chronic opioid therapy in nonmalignant pain. J Pain Symptom Manage 1990, 5(suppl 1):S46-S62.PubMedGoogle Scholar
  19. 19.
    Portenoy RK: Opioid therapy for chronic nonmalignant pain and current status. In Pain Research and Management, vol 1. Edited by Fields HL, Liebeskind JC. Seattle: IASP Press; 1994:247–287.Google Scholar
  20. 20.
    Passik SD, Portenoy RK: Substance abuse issues in palliative care. In Principles and Practice of Supportive Oncology. Edited by Berger A, Portenoy RK, Weissman DE. Philadelphia: Lippincott-Raven Publishers; 1998:513–524.Google Scholar
  21. 21.
    Passik SD, Kirsh KL, Whitcomb LA, et al.: Pain clinicians’ rankings of aberrant drug-taking behaviors. J Pain Palliat Care Pharmacother 2002, 16:39–49.PubMedCrossRefGoogle Scholar
  22. 22.
    Passik SD, Kirsh KL, McDonald MV, et al.: A pilot survey of aberrant drug-taking attitudes and behaviors in samples of cancer and AIDS patients. J Pain Symptom Manage 2000, 19:274–286.PubMedCrossRefGoogle Scholar
  23. 23.
    Rinaldi RC, Steindler EM, Wilford BB, Goodwin D: Clarification and standardization of substance abuse terminology. JAMA 1988, 259:555–557.PubMedCrossRefGoogle Scholar
  24. 24.
    Weissman DE, Haddox JD: Opioid pseudoaddiction: an iatrogenic syndrome. Pain 1989, 36:363–366. This article describes the phenomenon of pseudoaddiction in patients with pain who are undertreated for pain.PubMedCrossRefGoogle Scholar
  25. 25.
    Hay JL, Passik SD: The cancer patient with borderline personality disorder: suggestions for symptom-focused management in the medical setting. Psychooncology 2000, 9:91–100.PubMedCrossRefGoogle Scholar
  26. 26.
    Passik SD, Portenoy RK, Ricketts PL: Substance abuse issues in cancer patients part 1: prevalence and diagnosis. Oncology 1998, 12:517–521.PubMedGoogle Scholar
  27. 27.
    Brookoff D: Abuse potential of various opioid medications. J Gen Intern Med 1993, 8:688–690.PubMedCrossRefGoogle Scholar
  28. 28.
    U.S. Dept. Health & Human Services/SAMHSA/OAS: Emergency Department Trends From the Drug Abuse Warning Network, Final Estimates 1994–2001. Pub D-21, August 2002.Google Scholar
  29. 29.
    Katz N, Fanciullo GJ: Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain 2002, 18(suppl 4):S76-S82. This article describes the results of urine toxicology screening in patients with and without evidence of noncompliance with opioid therapy.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Steven D. Passik
    • 1
  • Kenneth L. Kirsh
  1. 1.Symptom Management and Palliative Care Program, Markey Cancer CenterUniversity of KentuckyLexingtonUSA

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