GLASGOW-Pain specialists continually stress the message that clinicians
should not fear prescribing adequate doses of opioids for pain
patients, since such patients are not at risk of becoming "addicted."
Now a study from the University of Glasgow confirms what pain
specialists intuitively know: Pain patients do not become psychologically
dependent on drugs because they are taking narcotics to relieve
their pain and for no other reason; drug abusers, on the other
hand, use narcotics strictly for mood alteration or to induce
The researchers surveyed three groups who were receiving narcotics:
cancer pain patients (14 subjects), patients with chronic nonmalignant
pain (27 subjects), and drug addicts enrolled in a methadone maintenance
program (30 subjects).
The cancer pain patients had been using opioids for a mean of
6 months; the chronic pain patients for 2.2 years; and the drug
abusers for 13 years. Median daily morphine equivalent doses were
much higher in the cancer patients (1,320 mg) than in the chronic
pain patients (700 mg) or the drug abusers (160 mg).
Patients' drug use and reasons for varying the dose were recorded
daily for a week, then weekly for a month, then once monthly for
3 months, via structured questionnaires and semi-structured interviews,
Dr. Marie Fallon, of the Division of Palliative Medicine, reported
in a poster session at the 8th World Congress on Pain in Vancouver.
The results showed that pain patients are not psychologically
dependent on strong opioids. "They have a need to use them
for pain, and when that pain isn't there, they basically don't
need them," Dr. Fallon said.
The cancer pain patients reported taking extra opioids when their
pain was poorly controlled, and the chronic pain patients said
they took extra doses when pain was more distressing, but, Dr.
Fallon said, the drug abusers' use of extra narcotics beyond what
they were getting in the maintenance program appeared to be based
on drug availability.