Highlights from Pain, Opioids, and Addiction: An Urgent Problem for Doctors and Patients

Frederick W. Burgess, MD, PhD

Disclosures

April 27, 2007

In This Article

Introduction

On March 5-6, 2007, the National Institute on Drug Abuse (NIDA) and the American Medical Association sponsored a joint meeting at the NIDA campus in Bethesda, to present information on opioid prescribing, chronic pain, and the increase in prescription drug abuse. (See the agenda at: http://conferences.masimax.com/opioid/agenda.cfm.)

The program was divided into 5 educational sessions featuring presentations by NIDA grant recipients and other experts in pain treatment and addiction medicine, followed by a commentary and panel discussion. The sections were Neurobiology of Opioids, Epidemiology of Opioid Addiction and Pain, Genetic Intersection of Pain and Addiction, Balancing Pain Relief, Risk for Addiction, and Treatment Development: Hope on the Horizon.

Overall, the discussions were extremely well balanced, demonstrating clear support and recognition of the value of opioid therapy for cancer and chronic noncancer pain conditions. Presentations by Dr. Kathleen Foley[1] of the Memorial Sloan Kettering Cancer Center and Dr. Nathaniel Katz[2] of Tufts University, served to highlight the great strides that have been made in the treatment of cancer pain and chronic pain. Both physicians cited the difficulty encountered by physicians caring for pain patients in trying to provide compassionate care to the patient in need of opioid analgesics, and the concern for the social and legal ramifications of prescription drug diversion. The value of opioid therapy in acute traumatic pain and for cancer pain is no longer controversial, although some improvement is still needed. Chronic opioid therapy for chronic pain conditions continues to be surrounded by considerable controversy. This in part stems from a lack of well-controlled clinical trials of sufficient duration (years), because much of the data available is of only intermediate duration. Furthermore, the high incidence of mental health disorders and substance misuse among chronic pain populations has created much concern. Coupled with the rising death rate attributed to accidental prescription drug overdose, there is a need for a closer look at the links between pain and addiction.[3]

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