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Chemical coping versus pseudoaddiction in patients with cancer pain

Published online by Cambridge University Press:  13 February 2014

Jung Hye Kwon ,
Kimberson Tanco ,
David Hui ,
Akhila Reddy  and
Eduardo Bruera
Jung Hye Kwon
Affiliation:
Division of Hemato-oncology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Kimberson Tanco*
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
David Hui
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Akhila Reddy
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Eduardo Bruera
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Address correspondence and reprint requests to: Kimberson Tanco, Department of Palliative Care and Rehabilitation, Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas77030. E-mail: [email protected].
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Abstract

Objective:

The purpose of this case series was to describe patients with aberrant drug-related behaviors and similar patterns of dose escalation in whom interdisciplinary assessment revealed different bases for their dose increases.

Method:

During the period from December 26 to December 30, 2011, the medical records of two patients with opioid-related aberrant behaviors were reviewed.

Results:

We described two patients with a significant cancer history and different comorbidities who presented with different aberrant drug-related behaviors and opioid requirements.

Significance of Results:

Opioid-related aberrant behaviors can be interpreted in different ways, and two of the more common syndromes in cancer patients are chemical coping and pseudoaddiction. In advanced cancer patients, the boundaries between these conditions are not as clear, and diagnosis is often made retrospectively. Furthermore, there have been relatively limited studies describing these two syndromes. Thus, they continue to pose a diagnostic and treatment challenge that requires different approaches for effective management of symptoms. The key characteristic between the two syndromes is that the behaviors displayed in chemical coping are motivated by obtaining opioids to relieve psychosocial distress, while in pseudoaddiction these behaviors are motivated by uncontrolled nociceptive input. Close monitoring of the pain syndromes, aberrant behaviors, and opioid requirements over several visits is usually necessary to distinguish the two syndromes.

Keywords

Chemical copingPseudoaddictionCancer painAberrant behaviorsopioid pain management
Type
Case Reports
Information
Palliative & Supportive Care , Volume 12 , Issue 5 , October 2014 , pp. 413 - 417
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Boscarino, J.A., Rukstalis, M., Hoffman, S.N., et al. (2010). Risk factors for drug dependence among outpatients on opioid therapy in a large US healthcare system. Addiction, 105(10), 1776–1782.Google Scholar
Bruera, E., Moyano, J., Seifert, L., et al. (1995). The frequency of alcoholism among patients with pain due to terminal cancer. Journal of Pain and Symptom Management, 10, 599–603.CrossRefGoogle ScholarPubMed
Deandrea, S., Montanari, M., Moja, L., et al. (2008). Prevalence of undertreatment in cancer pain: A review of published literature. Annals of Oncology, 19, 1985–1991.Google Scholar
Edlund, M.J., Steffick, D., Hudson, T., et al. (2007). Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain, 129(3), 355–362.Google Scholar
Ewing, J.A. (1984). Detecting alcoholism: The CAGE questionnaire. The Journal of the American Medical Association, 252, 1905–1907.CrossRefGoogle ScholarPubMed
Kircher, S., Zacny, J., Apfelbaum, S.M., et al. (2011). Understanding and treating opioid addiction in a patient with cancer pain. Journal of Pain, 12, 1025–1031.Google Scholar
Lawlor, P., Walker, P., Bruera, E., et al. (1997). Severe opioid toxicity and somatization of psychosocial distress in a cancer patient with a background of chemical dependence. Journal of Pain and Symptom Management, 13(6), 356–361.CrossRefGoogle Scholar
Lusher, J., Elander, J., Bevan, D., et al. (2006). Analgesic addiction and pseudoaddiction in painful chronic illness. The Clinical Journal of Pain, 22, 316–324.Google Scholar
Mayfield, D., McLeod, G. & Hall, P. (1974). The CAGE questionnaire: Validation of a new alcoholism screening instrument. The American Journal of Psychiatry, 131, 1121–1123.CrossRefGoogle ScholarPubMed
Passik, S.D. (2009). Issues in long-term opioid therapy: Unmet needs, risks, and solutions. Mayo Clinic Proceedings, 84(7), 593–601.Google Scholar
Passik, S.D. & Kirsh, K.L. (2005). Managing pain in patients with aberrant drug-taking behaviors. Supportive Oncology, 3(1), 83–86.Google ScholarPubMed
Passik, S.D. & Kirsh, K.L. (2008). Chemical coping: The clinical middle ground. In Pain and chemical dependency. Smith, H.S. & Passik, S.D. (eds.), pp. 299–302. New York: Oxford University Press.Google Scholar
Passik, S.D., Kirsh, K.L., McDonald, M.V., et al. (2000). A pilot survey of aberrant drug-taking attitudes and behaviors in samples of cancer and AIDS patients. Journal of Pain and Symptom Management, 19, 274–286.Google Scholar
Passik, S.D., Kirsh, K.L., Donaghy, K.B., et al. (2006). Pain and aberrant drug-related behaviors in medically ill patients with and without histories of substance abuse. The Clinical Journal of Pain, 22, 173–181.Google Scholar
Pathan, H. & Williams, J. (2012). Basic opioid pharmacology: An update. British Journal of Pain, 6, 11–16.Google Scholar
Porter-Williamson, K., Heffernan, E. & Von Gunten, C.F. (2003). Pseudoaddiction. Journal of Palliative Medicine, 6, 937–939.Google Scholar
Weissman, D.E. & Haddox, J.D. (1989). Opioid pseudoaddiction: An iatrogenic syndrome. Pain, 36, 363–366.Google Scholar
World Health Organization (WHO) (2011). Ensuring balance in national policies on controlled substances. Geneva: WHO.Google Scholar