title: Pain Control in the Presence of Drug Addiction.
abstract: Drug addiction is present in a significant proportion of the population in the USA and worldwide. Drug addiction can occur with the abuse of many types of substances including cocaine, marijuana, stimulants, alcohol, opioids, and tranquilizers. There is a high likelihood that clinicians will encounter patients with substance abuse disorders on a regular basis with the prevalence of the use of illicit substances and the high rate of abuse of prescription drugs. The use of abuse deterrent formulations of prescription opioid agents, pill counts, and urine drug abuse screenings are all useful strategies. Optimum pain management of patients with addiction in the outpatient and inpatient setting is essential to minimize pain states. Careful selection of medications and appropriate oversight, including drug agreements, can reduce drug-induced impairments, including sleep deficits and diminished physical, social, and sexual functioning. This review, therefore, discusses the prevalence of illicit and prescription drug addiction, the challenges of achieving optimum pain control, and the therapeutic approaches to be considered in this challenging population. More research is warranted to develop improved therapies and routes of treatments for optimum pain relief and to prevent the development of central sensitization, chronic pain, and impaired physical and social functioning in patients with drug addiction.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 06520, USA. Nalini.vadivelu@yale.edu.
authors.forename: Nalini
authors.initials: N
authors.lastname: Vadivelu
authors.affiliation: Yale University School of Medicine, New Haven, CT, 06520, USA.
authors.forename: Leandro
authors.initials: L
authors.lastname: Lumermann
authors.affiliation: Yale University School of Medicine, New Haven, CT, 06520, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Zhu
authors.affiliation: California North State University College of Medicine, 9700 W Taron, Elk Grove, CA, 95757, USA.
authors.forename: Gopal
authors.initials: G
authors.lastname: Kodumudi
authors.affiliation: Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA.
authors.forename: Amir O
authors.initials: AO
authors.lastname: Elhassan
authors.affiliation: Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016739:Behavior, Addictive / Q000188:drug therapy*; D059350:Chronic Pain / Q000188:drug therapy*; D006801:Humans; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D059408:Pain Management; D015995:Prevalence
chemical_list: D000701:Analgesics, Opioid
keywords: Abuse deterrent formulation; Addiction; Analgesia; Illicit drug abuse; Opioid; Prescription drug abuse; Tolerance