Karen Miotto, M.D.
Professor, Department of Psychiatry and Behavioral Sciences
Director, UCLA Addiction Medicine Service
UCLA David Geffen School of Medicine
April 13, 2012
Assessment of addiction in the patients with chronic nonmalignant pain receiving long term opioid therapy is a challenging clinical task. The importance of addiction screening before the initiation of opioids and the assessment of medication use in a patient already established on opioid treatment will be discussed. Chronic pain can have a debilitating impact on the quality of daily life. Opioids are useful for the treatment of chronic non-malignant pain in selected patients but the benefits must be balanced with the risk of problematic medication use, addiction and a rising number of overdose deaths. Without adequate knowledge of the patients' susceptibility to, or current substance misuse or addiction, it is impossible to establish and maintain safe and effective treatment with opioid analgesics.
This presentation addresses the types of screening used to determine an appropriate assessment for pain and addiction. These types of evaluations will better aid physicians in determining if long term opioid analgesia is a viable option for a patient with chronic pain. The methods, benefits and limitations of using these screening and assessment techniques are discussed, as well as the complex nature of chronic pain and addiction. Underlying factors that contribute to the causes of chronic pain, and may also factor into drug addiction, are also addressed.
In addition, Dr. Miotto also advocates for obtaining collateral information from family members, the use of prescription monitoring programs and working in collaborative teams with medical and psychiatric healthcare providers and pharmacists.