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Pain and Addiction

By Comprehensive Pain Medicine
Pain Management and Addiction Medicine Expert Witness
Pain and addiction can often co-exist. Approximately 33% of the population has tried illicit drugs, and about 6.5% actively abuse illicit drugs. Pain management and prescription drug addiction is a serious health crisis facing the world today. The author examines the disadvantages of this situation.

Pain and addiction can often coexist. Approximately 33% of the population has tried illicit drugs, and about 6.5% actively abuse illicit drugs. It is also estimated that 21% of the population has taken at least once, prescription drugs for non-prescribed uses. In 2002, over 2 million people in the United States abused the drug Oxycontin, and that number is most likely double today. The incidence of addiction in the general population is 6-15%, and in the chronic pain population is most likely higher. Many physicians prescribe opioid pain medications with good intentions. However, it has become increasingly evident that opioids as monotherapy for chronic pain may be problematic.

Rational polypharmacy with the use of antidepressants, antiepileptics, interventional pain management, and behavioral therapy should be utilized as well.

Opioid hyperalgesia
Some patients, when being treated with moderate to high doses of opioid medications, develop a syndrome of hyperalgesia which is a state of increased pain. It is counterintuitive to believe that powerful medications that are designed to treat pain can actually create more pain. However, there is neurobiological basis for this which involves the down regulation of opioid receptors by other neurotransmitters. When patients are detoxified from opioids, their pain often diminishes and they can then be treated with non-opioid medications and interventional techniques.


ABOUT THE AUTHOR: Sanford M. Silverman, MD
Sanford M. Silverman, MD, is in private practice as the medical director and CEO of Comprehensive Pain. He is on the board of the Florida Academy of Pain Medicine, the Florida Society of Interventional Pain Physicians and of the Florida Pain Initiative, a non-profit organization dedicated to the treatment of pain for Florida residents through education, clinical practice and patient advocacy. Dr. Silverman is also on the Broward County Task Force for Prescription Medication Abuse, which is devoted to preventing prescription medication abuse, diversion and addiction.

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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.For specific technical or legal advice on the information provided and related topics, please contact the author.

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