title: Management of chronic pain with chronic opioid therapy in patients with substance use disorders.
abstract: Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.
authors.affiliation: University of Buffalo School of Nursing, Buffalo, 3435 Main Street Wende Hall 201E, Buffalo, NY 14221, USA. yc73@buffalo.edu.
authors.forename: Yu-Ping
authors.initials: YP
authors.lastname: Chang
authors.forename: Peggy
authors.initials: P
authors.lastname: Compton
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D059408:Pain Management / Q000379:methods*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000517:prevention & control
chemical_list: D000701:Analgesics, Opioid