title: Chemical coping versus pseudoaddiction in patients with cancer pain.
abstract: OBJECTIVE
  The purpose of this case series was to describe patients with aberrant drug-related behaviors and similar patterns of dose escalation in whom interdisciplinary assessment revealed different bases for their dose increases.
  
  
  METHODS
  During the period from December 26 to December 30, 2011, the medical records of two patients with opioid-related aberrant behaviors were reviewed.
  
  
  RESULTS
  We described two patients with a significant cancer history and different comorbidities who presented with different aberrant drug-related behaviors and opioid requirements.
  
  
  CONCLUSIONS
  Opioid-related aberrant behaviors can be interpreted in different ways, and two of the more common syndromes in cancer patients are chemical coping and pseudoaddiction. In advanced cancer patients, the boundaries between these conditions are not as clear, and diagnosis is often made retrospectively. Furthermore, there have been relatively limited studies describing these two syndromes. Thus, they continue to pose a diagnostic and treatment challenge that requires different approaches for effective management of symptoms. The key characteristic between the two syndromes is that the behaviors displayed in chemical coping are motivated by obtaining opioids to relieve psychosocial distress, while in pseudoaddiction these behaviors are motivated by uncontrolled nociceptive input. Close monitoring of the pain syndromes, aberrant behaviors, and opioid requirements over several visits is usually necessary to distinguish the two syndromes.
authors: Division of Hemato-oncology,Department of Internal Medicine,Kangdong Sacred Heart Hospital, Hallym University College of Medicine,Seoul,Republic of Korea.
authors: Jung Hye
authors: JH
authors: Kwon
authors: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors: Kimberson
authors: K
authors: Tanco
authors: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors: David
authors: D
authors: Hui
authors: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors: Akhila
authors: A
authors: Reddy
authors: Department of Palliative Care and Rehabilitation Medicine,The University of Texas MD Anderson Cancer Center,Houston,Texas.
authors: Eduardo
authors: E
authors: Bruera
mesh_terms: D000223:Adaptation, Psychological / Q000187:drug effects*; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006853:Hydrocodone / Q000009:adverse effects / Q000627:therapeutic use; D004091:Hydromorphone / Q000009:adverse effects / Q000627:therapeutic use; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000523:psychology*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D006853:Hydrocodone; D004091:Hydromorphone