Addiction to opioids in chronic pain patients: A literature review
Version of Record online: 9 JAN 2012
2007 European Federation of Chapters of the International Association for the Study of Pain
European Journal of Pain
Volume 11, Issue 5, pages 490–518, July 2007
How to Cite
Højsted, J. and Sjøgren, P. (2007), Addiction to opioids in chronic pain patients: A literature review. European Journal of Pain, 11: 490–518. doi: 10.1016/j.ejpain.2006.08.004
- Issue online: 9 JAN 2012
- Version of Record online: 9 JAN 2012
- Received 20 February 2006; Revised 28 August 2006; accepted 30 August 2006
- Chronic pain;
- Screening tools;
Opioids have proven very useful for treatment of acute pain and cancer pain, and in the developed countries opioids are increasingly used for treatment of chronic non-malignant pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria, incidence and prevalence of addiction in opioid treated pain patients, screening tools for assessing opioid addiction in chronic pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and chronic non-malignant pain patients.
The review indicates that the prevalence of addiction varied from 0% up to 50% in chronic non-malignant pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid treatment as addiction may result in poor pain control. Several screening tools were identified, but only a few were thoroughly validated with respect to validity and reliability.
Most of the identified guidelines mention addiction as a potential problem. The guidelines in cancer pain management are concerned with the fact that pain may be under treated because of fear of addiction, and the guidelines in management of non-malignant pain patients include warnings of addiction. According to the literature, it seems appropriate and necessary to be aware of the problems associated with addiction during long-term opioid treatment, and specialised treatment facilities for pain management or addiction medicine should be consulted in these cases.