Addiction Definitions

There are many definitions of addiction. The American Psychiatric Association (APA) does not endorse the use of the "addiction" at all, instead the organization uses the term "use disorder" (e.g. alcohol use disorder). "A substance use disorder describes a problematic pattern of using alcohol or another substance that results in impairment in daily life or noticeable distress. A person with this disorder will often continue to use the substance despite consequences." According to the APA, substance use disorders may be mild to severe. As an example, intermittent heavy drinking that results in marital difficulties would not be considered a severe alcohol use disorder (i.e. alcoholic) but it would be a "use disorder".  About a third of people with chronic pain have a "use disorder" of some type. (Chang Y, Compton P 2013)

Other definitions of addiction include:

".. a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors." ( National Institute on Drug Abuse)


"Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems in one's behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death." (American Society of Addiction Medicine)

Addiction Magnifies Pain-related Disability

As noted above addiction is a progressive disease. Untreated, it leads to deterioration in physical and social function. Addiction usually magnifies pain and pain-related disability. Pain is unlikely to improve unless addiction is addressed.

Buprenorphine, Methadone and Pain

Methadone

Methadone is a proven treatment for opioid addiction, but it is best viewed as a "last resort" treatment for those who cannot maintain sobriety despite other treatments. Many people with chronic pain end up in methadone clinics, some became addicted when they "self-medicated" with opioid and others because they were "cut off" by prescribing clinicians because they overused or abused prescribed medications. Since methadone is an opioid and is sometimes prescribed in low doses to treat chronic pain, it may seem logical that methadone maintenance in a clinic setting will control chronic pain, but this is not the case. When methadone prescribed for pain, it is used consumed 3-4 times a day, not once a day in high doses. Research has shown that methadone maintenance is associated with increased pain-- not less--perhaps due to opioid-induced hyperalgesia.

Buprenorphine

In the U.S. buprenorphine is FDA indicated for the treatment of chronic pain in a low-dose patch applied to the skin (Butrans®) as for the treatment of opioid dependence (addiction) in high strength sublingual (i.e. under the tongue) preparations in brand name (e.g. Suboxone ) and in generic formulations. These high strength sublingual formulations are increasingly prescribed "off-label" to treat chronic pain in situations when patients are believed to be either addicted or at high risk for addiction. There are pro's and con's to buprenorphine treatment. Read more.