For the Public

Pain and Addiction

Pain management is an important component of high-quality compassionate medical care.  While there are many pain treatment modalities available to providers, pharmacotherapy is an increasingly prevalent treatment method; opioid analgesics are among the most popular classes of drugs indicated for pain treatment. 
For persons with risk factors for addiction, exposure to potentially rewarding substances, like opiates, may reinforce drug taking behavior and therefore present special risks. The following resources are intended to inform you about the intersection of pain and addiction and to help guide treatment decisions related to this particular co-morbidity.

For Providers

ASAM Pain and Addiction: Common Threads Conference
International Association for the Study of Pain: Clinical Updates
Rights and Responsibilities of Health Care Professionals in the Use of Opioids for the Treatment of Pain: Consensus Statement of the American Pain Society, the American Academy of Pain Medicine, and the American Society of Addiction Medicine
TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction (SAMHSA, Treatment Improvement Protocol Series)

Prescription Drugs and Addiction

Prescription Drugs: Abuse and Addiction (NIDA)
Addiction by Prescription (SAMHSA)
Prescription Painkiller Overdoses in the United States (CDC Vital Signs Report)
Office of National Drug Control Policy Prescription Drug Abuse Prevention Plan
Combating Prescription Drug Abuse and Diversion (American Medical Association)

 

Pain in Addiction Medicine

Pain Links of Interest

American Pain Society
American Academy of Pain Medicine
American Board of Pain Medicine
C.A.R.E.S. Alliance
International Association for the Study of Pain
University of Wisconsin Pain and Policy Studies Institute

ASAM Committee on Pain and Addictive Disease

Federal Regulations for Prescribing a Scheduled Controlled Substance (updated 11-1-2010)
DEA: Pain Management In Addiction Medicine  [NEED TO CREATE]

ASAM Public Policy Statements Related to Pain

Definitions Related to the Use of Opioids for the Treatment of Pain [NEED TO CREATE]
Rights and Responsibilities of Health Care Professionals in the Use of Opioids for the Treatment of Pain [NEED TO CREATE]

International Association for Pain and Chemical Dependency

The organization serves to address the common issues related to the interface of pain and addiction in an international forum. Please look here for more details about this newly formed organization in the near future.  For more immediate information and membership applications, please contact Dr Ian Buttfield at buttfield@ozemail.com.au.

Definitions Related to Opioid Management of Pain

Inconsistent use of terms such as addiction, dependence and tolerance, often results in misunderstandings between regulators, health care providers, patients and the general public regarding the use of medications for the treatment of pain. Because of these misunderstandings, pain is often under treated and individuals may be stigmatized because of their use of opioids for medical purposes. The Liaison Committee on Pain and Addiction (LCPA) is working to develop definitions related to the use of medications for the treatment of pain that are consistent with current understanding of relevant neurobiology, pharmacology and appropriate clinical practice. The ultimate goal of this project is to achieve acceptance and use of uniform definitions by clinicians, regulators and the public, both nationally and internationally, in order to promote appropriate treatment of pain throughout the world.

The LCPA is nearing consensus on the definitions. The next steps will be review of the draft definitions by the component organization Boards, and solicitation of comment by key Federal and International groups, including the Institute of Medicine, the World Health Organization, the International Association for the Study of Pain, the US Drug Enforcement Agency, and agencies of the U. S. Department of Health and Human Services including the National Institute on Drug Abuse, the Food and Drug Administration and the Centers for Substance Abuse Treatment. Once finalized, the LCPA will work to bring the definitions into common acceptance and usage.

Development of a Core Curriculum in Pain Medicine and Addiction Medicine

There is currently burgeoning interest in the overlapping areas of pain medicine and addiction medicine. This project is intended to define the body of knowledge necessary for health care providers to provide safe and effective therapy of pain, to identify and manage addictive disorders in patients with pain and to treat pain in individuals with addictive disorders. It will include essential knowledge in overlapping areas of interest in the fields of pain medicine and addiction medicine. Due to the different focuses of their work, generalist physicians and various specialists, both physicians and non-physicians, need to have various depths of knowledge in different parts of this curriculum, but it is believed that all practitioners who treat pain as a prominent part of their practice, should have a basic level of understanding of all parts of the curriculum.

It is anticipated that the defined body of knowledge (core curriculum) will be used selectively as a template to develop courses, conferences, training curricula and other educational projects, as well as, as a reference standard for the development of certification criteria in the fields of pain medicine and addiction medicine.

Media Response System

Issues frequently come to public attention that are within the domains of interest of both Pain Medicine and Addiction Medicine. Often, these merit a coordinated response from professionals in both fields. The LCPA has developed a system that allows the American Pain Society, the American Academy of Pain Medicine and the American Society of Addiction Medicine to respond to clinical, regulatory and policy issues in a coordinated and effective manner. The system is currently available for activation as needed. It is anticipated that the organizations will speak with one voice in the future on such issues as pain-related legislation, physician practice patterns, pharmaceutical developments and regulatory decisions.

Assessment of Research Priorities

The LCPA is currently in the process of prioritizing research topics which the pain medicine and addiction medicine communities believe address questions of critical importance to the evolution of optimum pain treatment. The goal of this project is to help shape the availability of Federal, foundation and industry funding to projects that facilitate knowledge in relevant areas of pain and addiction medicine and that eliminate barriers to effective pain treatment.

Clinical Resource Identification related to Opioid Therapy of Pain

The LCPA is currently examining options that would allow physicians in the pain treatment community and the addiction treatment community to more readily identify clinicians with skills, experience or interest in pain medicine and addiction medicine. The purpose of this effort is to promote more consistent care when patients (or their physicians) relocate, and to facilitate specialty consultation when needed for complex patients. A variety of possible avenues for identification of such clinicians are being examined.