ABSTRACT
The first principle of management is to develop a positive physician-patient relationship. Although management of pain may often present a problem to the physician not thoroughly familiar with analgesic agents, the problem is most severe in persons who already have a tolerance to narcotics. This large heterogenous population can be classified into four major categories: persons currently dependent on physician-prescribed narcotics secondary to an underlying medical disorder; persons dependent on street narcotics without any underlying medical disorder preceding narcotic use, persons currently dependent on methadone prescribed through a methadone maintenance program, and persons with pain of undefined origin. Chronic pain most often localized to the joints as a result of deformities due to multiple episodes of bleeding are also not uncommon in hemophilia. The three medical issues a physician confronts in treating a heroin addict are: the current state of the addiction, the etiology, and the severity of the pain.
