One of the challenges faced by medical professionals is differentiating addiction from chronic pain in a patient. This difficulty dissipates once tolerance, physical and psychological dependence are properly defined and diagnosed.

a.) Tolerance is the need to increase a drugs dosage or frequency of use to achieve the same effect. In clinical practice, significant opioid tolerance is uncommon. Tolerance may be present in the pain patient or the addict; and cannot be viewed independently to accurately diagnose addiction.

b.) Physical dependence is the subsequent development of a withdrawal syndrome following discontinuation of the drug after prolonged use. Many patients taking opioids become physically dependent so that alone cannot be used to differentiate the pain patient from the addict.

c.) Psychological dependence, also referred to as addiction, is the overwhelming involvement in the acquisition and use of a drug, characterized by loss of control, compulsive drug use, and use despite harmful consequences.

Addiction is characterized by:

• Loss of control of drug use
• Continued use despite harmful effects on relationships, family, career and in spite of potential legal problems
• Illegal drug-seeking behavior
• Taking extra and not prescribed doses to get high or relieve pain
• Abuse of other substances
• Maintaining contact with others who are substance abusers
• Uncooperative behavior and negative attitude regarding treatment or adequately following up on treatment

Differential Diagnosis

Certain drugs prescribed to treat pain can be addictive and, when use is ceased, can result in withdrawal. Withdrawal symptoms occur when substance use is abruptly discontinued. Tolerance occurs when the initial dose of a substance loses its effectiveness over time; addiction and physical dependence often do occur together.

For example, people who take a class of drugs called opioids (e.g. codeine, OxyContin, Demerol and Vicodin) for prolonged periods may develop a tolerance and even physical dependence on the drug. This does not mean, however, that they are addicted. An individuals chances of becoming an addict are lowered when narcotics are used properly under medical supervision.

Some chronic pain sufferers are at a higher risk of becoming addicted than others. People who have been addicted to substances in the past or those with a family history of drug abuse are at increased risk of becoming chemically dependent. A few things one can do to avoid becoming addicted are:

a.) Always take your medicine as prescribed by your doctor.

b.) Make your doctor aware of your true individual or family history of substance abuse or addiction.

c.) Seek medical help if you suspect you are developing a drug alcohol addiction. It is normal for people to develop a tolerance to their pain medication and to need higher doses to achieve the same level of pain relief.

Such a situation is not necessarily a sign of addiction. However, you should inform your physician of any suspicions you may have that the drug use is becoming a problem.