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‘Pseudoaddicts’ Are Just Desperate Pain Patients Seeking Relief

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  • ‘Pseudoaddicts’ Are Just Desperate Pain Patients Seeking Relief

    ‘Pseudoaddicts’ Are Just Desperate Pain Patients Seeking Relief
    Los Angeles Bureau
    PALM S P R I N G S, CA L I F. —
    Patients suffering severe, inadequately
    treated chronic pain can
    closely resemble drug addicts,
    posing diagnostic and management
    challenges for primary
    care physicians, pain specialists,
    and addiction specialists.
    John Femino, M.D., calls them
    “pseudoaddicts,” a term developed
    in the past few years to
    characterize patients whose desperation
    to obtain relief may
    look a lot like an addict’s drugseeking
    Like addicts, such patients may
    have a loss of control over their
    medication use. They may seek
    early renewals or report that their
    medication was “lost” or “stolen.”
    Sometimes, as in the case of a
    patient treated at his recovery
    center, the unresolved pain will
    lead to true addiction, said Dr.
    Femino, who practices addiction
    medicine in North Kingston, R.I.
    This patient had previously
    unrecognized bone fragments
    left in his spine after unsuccessful
    surgery, causing excruciating
    pain. The patient’s addiction and
    the source of his pain had to be
    treated in a collaborative, multidisciplinary
    fashion, Dr. Femino
    said at the annual meeting of
    the American Academy of Pain
    Several tip-offs can help to distinguish
    addiction from pseudoaddiction.
    Importantly, a pseudoaddict is
    likely to keep appointments and
    to welcome nonpharmacologic
    adjuncts to medication.
    “If I say, ‘I’ve got a great physical
    therapist, 8% of our patients
    who go to him lower the dose of
    their pain medications,’ the
    pseudoaddict will say, ‘Great! Get
    me an appointment as soon as
    you can.’ ”
    An addict is much more likely
    to dismiss the offer out of hand,
    saying it won’t work, Dr. Femino
    Addicts are also less compliant
    with psychological and other
    nondrug interventions and fail
    to report any pain relief whatsoever
    from them.
    Chronic pain patients’ biggest
    fear is becoming addicted. They
    may express concern about the
    possibility, rather than waiting
    for the physician to bring it up.
    Another important element in
    sorting out addiction and
    pseudoaddiction is simply the family
    history, Dr. Femino stressed.
    “I believe the single biggest determinant
    of addiction is genetic,”
    he said.
    Although the DSM-IV does not
    include a positive family history
    in the diagnosis of addiction,
    100% of the patients in Dr. Femino’s
    recovery center report a family
    history of alcoholism or drug
    Patients with chronic pain
    who do have such a history merit
    special attention, such as more
    frequent counseling appointments,
    therapeutic drug monitoring,
    and stepped-up use of
    modalities such as physical therapy,
    he said.

  • #2
    Moderator, please move to Pain forum. Accidentally posted here.