Psychiatry

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Treatment Selection in Substance Abusers with Pain
Advances in Pain Management, 06/30/09

Manubay JM et al. - The treatment of chronic pain in substance abusers poses a clinical challenge in light of the broader availability, increased abuse, and diversion of prescription opioids. By reviewing the various factors that contribute to the pain experience and assessing the presence of mood disorders or aberrant behaviors, chronic pain in substance abusers may be managed successfully. Treatment agreements, urine toxicology testing, and psychiatric assessments should be routinely used. Additional instruments for assessing pain, emotional and physical functioning, quality of life, pain beliefs, coping strategies, and addiction risk provide structure and help to facilitate an understanding of pain and methods of coping. Continual assessment of these factors can then guide the clinician throughout the course of treatment. Delineating rules at the first encounter with a patient by using a treatment agreement enables clinicians to identify problematic behaviors and address these accordingly. Stratifying patients into risk categories for addiction liability will make it easier for a clinician to determine individualized treatment strategies, including the need for outside referrals.

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