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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Abuse liability testing of opioid drugs was originally motivated by attempts to separate the analgesic effects of opioids from their likelihood for abuse. It has become apparent that the human population group likely to abuse opioids has little overlap with the population group requiring opioids to treat pain, therefore there is no longer a need to separate these two properties of opioids. This is fortunate, since, as reviewed here by Jim Woods and colleagues, the results of the plethora of studies that have attempted to distinguish these two properties in known opioids strongly indicate that they are inseparable. Evaluation of the abuse potential of novel opioids remains, however, critically important in deciding on governmental restrictions on their accessibility. In addition, opioid abuse liability testing contributes enormously to our understanding of the behavioral mechanism of action of these drugs, and in surprising and helpful ways has increased our appreciation of the various test systems used to garner information about them.
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PMID:Use of in vivo apparent pA2 analysis in assessment of opioid abuse liability. 150 22

The basic thesis of this article is that addictive substances, because of their need-grafifying and self-medication value, become so central to the life of the addicted person that their absence is associated with a grief reaction. Painful feelings of loss and helplessness accompany drug surrender. This view contrasts with formulations that indicate that mourning experiences observed in recovering persons are specific to and determined by unresolved past losses of loved ones. The author discusses the theoretical underpinnings of the drug-loss grief reaction. Also presented are case vignettes that demonstrate the grief aspects of drug surrender. Finally, the role of brief psychotherapy as a vehicle for helping clients cope with their grief reactions is discussed.
J Subst Abuse Treat 1991
PMID:To surrender drugs: a grief process in its own right. 178 46

Recent reports suggest that opioid maintenance may be appropriate for treatment-resistant patients with chronic nonmalignant pain syndromes. However, a history of substance abuse is thought to be a contraindication for such treatment. We present a pilot study of a methadone maintenance-type treatment for patients with both chronic pain and substance abuse, evaluating the ability to attract and hold patients, the methodology for assessing change, and the potential problems and pitfalls. Weekly random urinalysis, weekly psychotherapy, and quarterly self-report tests of pain, mood, and function were used to evaluate change. Three out of 4 patients remained in treatment for 19-21 months, stopped needle use, and/or markedly decreased substance abuse, and appear to have improved functionally. Surprisingly, all 3 patients had significant psychopathology requiring treatment with psychotropic medication. This treatment may warrant further research.
J Subst Abuse Treat 1990
PMID:Chronic pain and substance abuse: a pilot study of opioid maintenance. 198 Dec 44

An attempt is made to contribute toward a unifying theory of alcoholism with the concept of "pain phobia" as its central factor. A brief theoretical exposition of pain phobia is offered and results of an empirical study are presented which lend considerable support to the position that pain phobia may be a central factor underlying alcoholism. The research utilizes the Pain Phobia Scale (PPS) as the measure of pain phobia and finds that pain phobia is present to a significantly greater degree in problem drinkers than a norm group and that pain phobia also discriminates non-problem drinkers in the degree of their consumption of alcohol. Suggestions are made for how the concept of pain phobia and the PPS can be useful in the treatment and prevention of alcoholism. The possible relationship between pain phobia and all addictions is also considered.
Adv Alcohol Subst Abuse 1990
PMID:Alcohol consumption and pain phobia: toward a unifying theory of alcoholism. 234 97

The history of physical and sexual abuse in childhood and adulthood was assessed in 31 women with chronic pelvic pain, 142 women with chronic pain in other locations, and 32 controls. Thirty-nine percent of patients with chronic pelvic pain had been physically abused in childhood. This percentage was significantly greater than that observed in other chronic-pain patients (18.4%) or controls (9.4%), though the prevalence of childhood sexual abuse did not differ among the groups (19.4, 16.3, and 12.5%, respectively). Abuse in adulthood was less common and was not significantly more likely to have occurred in patients with chronic pelvic pain than in other chronic-pain patients or controls. These data suggest that pelvic pain is unlikely to be specifically and psychodynamically related to sexual abuse but that the pernicious nature of abuse, whether physical or sexual, may promote the chronicity of painful conditions.
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PMID:History of physical and sexual abuse in women with chronic pelvic pain. 235 71

The history of cocaine is charted with specific reference to its usefulness as a medicine and local anesthetic. It is common knowledge that coca leaves were used as a panacea and local anesthetic throughout the history of the Incan Empire of Peru. In Europe, however, its medical usefulness was not fully recognized until Carl Koller used it to anesthetize the cornea of the eye. Over the next 20 years, cocaine became a popular medicine and tonic in Europe and America, where it was credited with curing a wide variety of diseases and illnesses. However, reports soon started to appear claiming that cocaine was a drug with a high social abuse potential and in America it seemed to underpin growing crime figures. As a result, cocaine was misclassified as a narcotic and its use was restricted to specific surgical procedures and medicinal preparations. Today, cocaine and its derivatives are still popular local anesthetics in operations of the ear, nose and throat and it is also used in a preparation given to alleviate the pain (physical and mental) of terminal diseases. Although cocaine has a high public profile as a drug of addictive potential, this drug has also had a long and distinguished history as a medicine and local anesthetic. The legitimate uses of cocaine exacerbate the problems of controlling this substance of abuse and should provide a stimulus for generating local anesthetics that lack addictive potential.
J Subst Abuse 1989
PMID:A review of the history, actions, and legitimate uses of cocaine. 248 53

Chronic pain syndromes arise when usual strategies to treat pain and its underlying pathology fail, excessive reliance on medication is related to increased dysfunction and, there is suspicion of psychiatric component to the pain behaviors exhibited. Opiate and sedative medications are generally cited as a contributing factor in the development of chronic non-malignant pain. The recent proliferation of clinics specializing in treatment of chronic pain and related disorders is a new and interesting development. These units consider detoxification from sedatives and opiates mandatory if chronic pain is to be treated and function restored. A literature review shows an amazing paucity of rigorous research in chronic pain patients which supports the widely held belief that medications contribute to dysfunction in chronic pain thus patients require detoxification. The following discussion explores the data upon which are based current strategies for the use of narcotics in chronic pain.
Adv Alcohol Subst Abuse
PMID:Prescribing practices for pain in drug dependence: a lesson in ignorance. 287 Jun 25

American physicians markedly undertreat severe pain based on an irrational and undocumented fear that appropriate use will lead patients to become addicts. Such irrational fear-opiophobia-resists educational intervention as phobic fears resist rational explanation and exploration. Because this phobia has become fixed in the customary behavior of physicians, it is particularly resistant to change. Re-education might better be directed to the changing of mistaken attitudes about drug use and abuse that are part of the American culture and which are not amenable to alteration by medical education.
Adv Alcohol Subst Abuse
PMID:American opiophobia: customary underutilization of opioid analgesics. 287 Jun 26

The dual diagnosis of AIDS and substance abuse raises serious clinical and ethical issues for health care providers. Often, there are barriers to the diagnosis and referral for substance abuse treatment in people with HIV infection. Countertransference is one such barrier. Important educational needs of patients can be overlooked or not fully addressed. Essential information needs to be conveyed, regardless of whether or not a patient seeks substance abuse treatment. Early intervention and treatment are essential to minimize risk for HIV infection and transmission to others. Specific clinical issues that practitioners often address for patients with AIDS or ARC are appropriate interventions for denial of the HIV-related diagnosis coupled with the denial of substance abuse, difficulties in pain management, the difficulties of family and loved ones, the need for substance abuse relapse prevention, and the need for coordination of care among agencies.
Adv Alcohol Subst Abuse 1987
PMID:Treatment of substance abuse in patients with HIV infection. 348 40

Treatment dropout is to drug abuse programs as pain is to cancer. Despite the endemic nature of the premature termination phenomenon, we have successfully reduced patient attrition from 50% to 20%. This article describes our clinical and empirical exploration into the dropout process and presents the major administrative and clinical changes that reduced our dropout rate. Once staff decide that patient dropouts are a staff problem rather than a patient problem, effective intervention can begin.
J Subst Abuse Treat 1985
PMID:Reducing the treatment drop out rate in drug abuse programs. 383 1


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