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Consensus and Controversies Between Pain and Addiction Experts on the Prevention, Diagnosis, and Management of
Mark Kraus1, Nicholas Lintzeris, Arun Bhaskar
1Yale University School of Medicine, New Haven, CT (MK); University of Sydney, Discipline Addiction Medicine; Drug and Alcohol Services South East Sydney Local Health District, Australia (NL); Department of Pain Medicine, Imperial College Healthcare NHS Trust, London, UK (AB); Department of Medicine, University of Helsinki, Helsinki, Finland (HA); University of Zurich, Zurich, Switzerland (EA); Centre d'Evaluation et Traitement de la Douleur, CHU Ambroise Paré, APHP, Boulogne-Billancourt; Université Versailles-Saint-Quentin, Versailles, France (DB); Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, València, Spain (GH); The OAD Clinic, London, UK (OD); Grenoble Alpes University Hospital, Department of Addiction Medicine; Grenoble Alpes University, Faculty of Medicine, France (MD); Institute for Pain Medicine/Pain Practice Wiesbaden, Germany (K-UK); Santa Chiara University Hospital, University of Pisa, Italy (IM); Pain Center, Cochin University Hospital, Descartes University, INSERM U 987, Paris, France (SP); University of Erlangen, Germany (RS); and Ross University School of Medicine, Miramar, FL (KP).
Objectives:
Prescription opioid use disorder (POUD) is an established public health crisis in many countries, and current evidence indicates it is a growing problem in Europe. Many specialists play a role, including pain and addiction medicine specialists, in the diagnosis and management of POUD, but neither group can fully address these patients' needs alone. The purpose of this consensus process was to bring together experts from pain and addiction medicine to examine the positions of both specialties.
Methods:
In all, 13 international pain medicine, addiction medicine, and addiction psychiatry experts convened a meeting to formulate a set of consensus statements on the diagnosis and management of POUD. The statements were further refined by a wider group of 22 European expert clinicians. At a second meeting of all 35 participants, a set of controversy statements was also developed to recognize some of the key areas of divergent opinion.
Results/Conclusions:
There was a high level of agreement between pain and addiction specialists. Key themes that emerged were the need to strengthen interdisciplinary communication, a desire for greater education and training for clinicians in both specialties, and mutual acknowledgment of the importance of multidisciplinary management of POUD. The blurred line between poorly managed pain and POUD was also a subject of much discussion, reflecting the difficulties in defining and diagnosing this complex condition.
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