Crossroads of pain and addiction.
BACKGROUND
Despite the fact that chronic pain and addiction often coexist, few pain training programs offer significant experiential and didactic training in drug abuse and addiction. Similarly, addiction medicine programs often offer little training in pain management. What follows is a review of the intersection between these two specialties from the perspective of clinicians that practice both.


OBJECTIVE
The objective of this study was to review the historical backdrop, terminology, vulnerability, and neurobiology of addiction; explore the effects of drug, delivery system, timing, and environment on drug self-administration; and review strategies used in managing patients with coexisting addiction and chronic pain.


METHODS
The University of Florida has training programs in both pain management and addiction medicine. The collaboration of these two subspecialties has led to the development of a successful pain management clinic that manages difficult patients based on the strategies that are discussed.


CONCLUSIONS
It is possible to successfully manage patients with coexisting chronic pain and addictive disorders. Addiction medicine and pain management training programs should offer didactic and experiential training in both subspecialties.
Pain and Addiction Medicine in the Division of Addiction Medicine, Department of Psychiatry, University of Florida's Springhill Health Center, Gainesville, FL32606, USA. baileyjo@ufl.edu
John A
JA
Bailey
Robert W
RW
Hurley
Mark S
MS
Gold
D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D000818:Animals; D016739:Behavior, Addictive; D004353:Drug Evaluation, Preclinical; D006801:Humans; D007049:Iatrogenic Disease; D009293:Opioid-Related Disorders / Q000209:etiology*; D010146:Pain / Q000150:complications* / Q000188:drug therapy*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000209:etiology
D000701:Analgesics, Opioid