Update: American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine Statement on Definitions Related to the Use of Opioids for the Treatment of Pain.
In 2003, as we enter the fourth "Decade of Pain Control" as established by the US federal government, significant barriers continue to impede patients' access to pain relief (Fox, 2003). One of these barriers, unrealistic fear of addiction from opioids to treat acute or chronic pain, remains prevalent among health professionals and consumers. In a joint statement in 2001, the American Academy of Pain Medicine (AAPM), American Pain Society (APS), and American Society of Addiction Medicine (ASAM) offered recommendations and definitions to guide the use of opioid therapy. Key definitions that should be used when assessing the treatment of pain with opioids are:
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following:
Physical dependence is a state of adaptation that often includes tolerance and is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist, such as naloxone (Narcan).
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects, such as pain relief, over time.
Individuals who have severe, unrelieved pain may become intensely focused on finding relief for their pain. Sometimes these patients may appear to others, including health professionals and family members, to be preoccupied with obtaining opioids, but the preoccupation is with finding relief of pain, rather than using opioids. This phenomenon has been termed 'pseudoaddiction' in the pain literature. A helpful intervention to identify pseudoaddiction is to ask the patient, "If you did not have pain, would you want to take the pain medicine?" Invariably, the answer is NO. However, a person addicted to opioids wants to take the analgesic regardless of existing pain.
Another difference between people taking opioids for pain relief as opposed to those who are truly addicted is their quality of life. Using opioids to relieve pain increases one's quality of life, whereas being addicted to opioids decreases one's quality of life. This distinction can also help nurses and other professionals reassure patients and their families that opioids as needed analgesics do not cause "street" addiction.
Because opioids can be abused, federal and state statutes and regulations govern their prescribing and dispensing. Consequently, a delicate balance exists between appropriate use of opioids as analgesics and their availability for abuse (Pain Policy, 2002). The concern for abuse and subsequent liability for physicians has discouraged many physicians and other health professionals with prescribing privileges from using opioids to treat pain. Several policies have been created to encourage effective pain management by addressing healthcare professionals concern about opioid analgesics. Nurses need to be aware of such resources to advocate for their patients to prevent needless suffering. These policies and other sources of regulatory information include:
March 7, 2003