Pain Management with Opioid Analgesics

Pseudoaddiction: Fact or Fiction? An Investigation of the Medical Literature

“…While the origins of these trends are attributable to the recognition of pain as a significant, undertreated public health problem [ 12 – 15 ], a growing emphasis on opioids as the major, front-line treatment of choice for pain has gone hand in hand with reducing physicians’ fears of opioids causing or contributing to addiction [ 16 , 17 ]. Pseudoaddiction, the subject of this review, is a clinical concept that has been influential as a diagnosis in clinical practice and the medical literature to indicate that under-treatment of pain, rather than risk of addiction with opioids, should be the primary clinical concern.…”

“…As contextualized by health insurance reimbursement and medication coverage plans that readily support opioid prescribing for pain diagnoses, while remaining relatively unsupportive of evidence-based treatments for addiction diagnoses [ 2 •, 27 •], these trends suggest that since the introduction of pseudoaddiction, health care has shifted too far in favor of treating pain with opioids. With a new and broadening consensus that the evidence base does not support the use of chronic opioids for chronic, non-terminal pain [ 4 , 5 , 15 , 17 , 28 – 32 , 33 ••], a literature review of pseudoaddiction is needed to inform opinions on whether the construct has been harmful or beneficial to patients, and whether it should survive or be abandoned.…”

Dexmedetomidine Infusion for the Management of Opioid-Induced Hyperalgesia

“…Opioid‐induced hyperalgesia (OIH) is characterized by a paradoxical increase in pain intensity, distribution, or sensitivity caused by prolonged or escalating doses of opioids [1]. Currently, there are no epidemiologic studies of incidence and prevalence of OIH [2]. As awareness of OIH is heightened, human studies are being performed to better understand this phenomenon.…”

“…While human studies for OIH are limited [2], there is a large body of evidence in animal studies [3–6,9–11]. Precise molecular mechanisms of OIH are still being uncovered.…”

Chronic opioid therapy clinical guidelines

“…1 Of the 1.5 million drug-related ED visits in 2005, 27% involved pharmaceuticals alone and 10% involved alcohol with pharmaceuticals. Prescription drug abuse rates increased by 542% in teens (ages 12 to 17) and 124% among adults between 1992 to 2002.…”