title: Clinical considerations in the treatment of chronic pain with opiates.
abstract: This article considers assessment and treatment issues for mental health practitioners working with patients using opiate medications to treat chronic pain with a particular emphasis on their potential relationship to substance abuse. We review general opiate medications, including a discussion of medications with increased addiction potential. Practice guidance is offered regarding long-term opiate treatment, including definitions of addiction, initial assessments, ongoing substance misuse monitoring, use of psychological assessment instruments, and managing medication misuse problems. Additionally, we examine the role of the mental health professional within this area and examine the incorporation of psychological interventions for patients using opiates. A case illustration includes several of these complicated issues of managing chronic pain with opiate medications.
authors.affiliation: Greater Los Angeles Veterans Affairs Healthcare System, UCLA Center for Neurovisceral Sciences and Women's Health, and David Geffen School of Medicine at UCLA, CA, USA. naliboff@ucla.edu
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Naliboff
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Wu
authors.forename: Quynh
authors.initials: Q
authors.lastname: Pham
mesh_terms: D000063:Accidents, Traffic; D000437:Alcoholism; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology; D010098:Oxycodone / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D010098:Oxycodone