ABSTRACT

There are a number of reasons pain clinicians have been historically interested in the area of addiction. At first, chronic pain clinicians had the clinical impression that pain treatment outcome was influenced by addiction issues (Fishbain et al., 1992b). As such, the mantra in the 1980s and the early 1990s was that chronic pain patients (CPPs) should be detoxified from opioids and that placement on opioids leads to addiction. This position radically changed in the late 1980s when publications began to appear claiming success in treating intractable CPPs with chronic opioid analgesic treatment (COAT) without the development of significant addiction (Portenoy, 1989; Portenoy & Foley, 1986). The COAT literature has increased and now contains a significant number of randomized controlled trials. They have recently been the subjects of a metaanalysis (Graven et al., 2000). Findings of this meta-analysis were that patients with nociceptive and neuropathic chronic pain may benefit from COAT, while this positive effect was less clear for patients with chronic idiopathic pain. Thus, because of the clinical interest in COAT as a way of helping intractable CPPs, addiction has become a hot topic within the pain literature.