Prescribing practices for pain in drug dependence: a lesson in ignorance

Chronic pain syndromes arise when usual strategies to treat pain and its underlying pathology fail, excessive reliance on medication is related to increased dysfunction and, there is suspicion of psychiatric component to the pain behaviors exhibited. Opiate and sedative medications are generally cited as a contributing factor in the development of chronic non-malignant pain. The recent proliferation of clinics specializing in treatment of chronic pain and related disorders is a new and interesting development. These units consider detoxification from sedatives and opiates mandatory if chronic pain is to be treated and function restored. A literature review shows an amazing paucity of rigorous research in chronic pain patients which supports the widely held belief that medications contribute to dysfunction in chronic pain thus patients require detoxification. The following discussion explores the data upon which are based current strategies for the use of narcotics in chronic pain.