Opioids and psychological issues: A practical, patient-centered approach to a risk evaluation and mitigation strategy

Authors

  • Michael R. Clark,

    Corresponding author
    1. Chronic Pain Treatment Programs, The Johns Hopkins Medical Institutions, Osler 320, 600 North Wolfe Street, Baltimore, MD 21287-5371, USA
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  • Steven A. Galati

    1. Chronic Pain Treatment Programs, The Johns Hopkins Medical Institutions, Osler 320, 600 North Wolfe Street, Baltimore, MD 21287-5371, USA
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Corresponding author. Tel.: +1 410 955 2126; fax: +1 410 614 8760. E-mail address: mclark9@jhmi.edu

Abstract

The use of long-term opioid therapy for the management of chronic pain remains controversial. The highlighted consequences of long-term opioid therapy are aberrant drug-taking behaviors, abuse, and dependence. However, the limitations of this treatment modality usually can be attributed to a lack of efficacy and adverse events. Patients that remain refractory to long-term opioid therapy for chronic pain often have a psychiatric disorder that is acting as a barrier to effectiveness. While standardized approaches to the evaluation of a patient to receive long-term opioid therapy are established, little data exists to document their ability to limit opioid abuse or enhance their efficacy. Screening questionnaires and other attempts at predicting or detecting opioid-related substance use disorders fail to determine the presence of comorbid psychiatric disorders. A comprehensive approach for the psychiatric evaluation of patients with chronic pain will address specific barriers to successful chronic pain management and optimize the chances for success with long-term opioid therapy.

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