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May 2010, Volume 40 Number 5 , p 60 - 61


  • Paul Arnstein PhD, RN


QUESTION: My patient has had back pain for years and keeps asking for more prescription pain relievers. How do I tell if he's a drug-seeker or really needs opioid analgesics for pain management?ANSWER: Opioids are considered medically necessary for many types of persistent pain and, in older adults, are safer than nonprescription pain relievers such as ibuprofen.1,2 Still, you may worry about being duped by patients who are feigning pain to support a drug habit, criminal activity, or an addiction. Or you may worry that giving the patient opioids may cause or worsen an addiction disorder, even though that occurs infrequently in patients being treated for chronic pain.3 On the contrary, unrelieved pain increases stress and drug craving, which can trigger illicit drug use or exacerbate an addiction disorder.4 A history of drug abuse or addiction shouldn't disqualify patients from receiving opioids for pain.The hallmark signs of an addiction disorder are excessive craving, compulsive

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