NEW YORK--Physicians and patients contribute to undertreatment of both cancer-related and acute noncancer pain because of unwarranted fear of addiction to pain medications, according to an expert on pain management.
Despite well-documented evidence that patients are routinely undermedicated, ineffective pain control continues to compromise recovery and quality of life for cancer patients during and after treatment. In fact, said Seddon Savage, MD, director, Outpatient Pain Clinic, Dartmouth-Hitchcock Medical Center, fear of addiction is usually unfounded.
"The use of opioids in pain management is permeated with mythology, controversy, and many misunderstandings," she said at a media briefing on pain, sponsored by the American Medical Association and Ortho-McNeil Pharmaceutical. She added that oversight by regulatory authorities further inhibits physicians in the use of these drugs.
Dr. Savage said that the fear of addiction is largely unwarranted, since individuals without a history of addictive disease rarely become addicted to medication for pain. "Most addicted individuals have a prior personal or family history of addiction of some type," she said, adding that these individuals likely have a biogenetic predisposition to addictive disease.
About 10% of the American population has an underlying addictive disorder, and individuals with one substance dependency are at increased risk for becoming addicted to another, she noted.
Dr. Savage defined addiction to prescription medication as drug-seeking behavior characterized by continued use of a drug despite adverse consequences; preoccupation with obtaining and using the drug while failing to comply with other aspects of treatment; and an inability to control the use of medications, including use of the drug in higher doses and with greater frequency than the physician has prescribed.
Patients with severe pain may engage in drug-seeking behavior, but it differs from addiction in that such behavior ceases as soon as adequate pain control is achieved, she said.