Crossroads of Pain and Addiction

Background. Despite the fact that chronic pain and addiction often coexist, few pain training programs offer significant experiential and didactic training in drug abuse and addiction. Similarly, addiction medicine programs often offer little training in pain management. What follows is a review of the intersection between these two specialties from the perspective of clinicians that practice both. Objective. The objective of this study was to review the historical backdrop, terminology, vulnerability, and neurobiology of addiction; explore the effects of drug, delivery system, timing, and environment on drug self-administration; and review strategies used in managing patients with coexisting addiction and chronic pain. Setting. The University of Florida has training programs in both pain management and addiction medicine. The collaboration of these two subspecialties has led to the development of a successful pain management clinic that manages difficult patients based on the strategies that are discussed. Conclusions. It is possible to successfully manage patients with coexisting chronic pain and addictive disorders. Addiction medicine and pain management training programs should offer didactic and experiential training in both subspecialties.