Addictions in pain clinics and pain treatment.

A great deal of fear exists in the world of pain management on the part of both healthcare professionals and some patients where issues of abuse, misuse, and addiction are concerned. While it might be easy to consider all pain patients as "drug seekers" or addicts, the reality remains that most pain patients are genuine; we therefore must retain pain management efforts for the many, while being aware and cognizant of the few who have problems such as addiction. To begin to separate these entities, definitions and hallmarks of addiction are explored along with discussion of screening tools that can be employed to help identify problematic patients. In addition, the concepts of dependence and tolerance are defined and separated from old notions of addiction. Finally, issues related to engaging in a multidisciplinary approach are discussed along with caveats regarding prescribing to patients who have histories or ongoing issues of addiction.