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Distinguishing Intractable Pain Patients from Drug Addicts

 The accurate and correct diagnosis of intractable pain (IP), while screening for individuals posing as pain patients in order to acquire drugs, has become a very critical matter. It is crucial to minimize the incidence of drug abuse and diversion and to safeguard legitimate pain treatment. For insurers, practical knowledge in this area of medicine is essential in limiting risk. Most dramatically, the “War on Drugs” has brought home to physicians the need to consistently and successfully distinguish legitimate pain patients from abusers and diverters. Failure to do so may now result in criminal charges against the practicing physician. Though this may be inappropriate, unfair, and draconian, it is now a fact of clinical life in pain management medicine.

Surprisingly, the differences between legitimate IP patients and addicts are relatively easy to clinically distinguish. This article presents the practical clinical knowledge necessary to accurately diagnose these disparate clinical conditions. Generalizations are made with the awareness that, while there are few absolutes and that some room must be allowed for exceptions and variety, analyses of tendencies, trends, commonalities, and frequencies yield useful clinical information. The following sections will first discuss the general characteristics of drug addicts posing as pain patients followed by a discussion of intractable pain patients.

General Characteristics of Addicts
Addicts are typically elusive regarding their medical history and cannot, or will not, provide their medical records. Some may have records only for multiple emergency room visits. Typically addicts will have seen multiple doctors while avoiding long-term relationships. They often have a legal history of drug-related problems, especially arrests for driving while intoxicated and don’t appear to learn from their errors.

Please refer to the May/Jun 2003 issue for the complete text. In the event you need to order a back issue, please click here.

Last updated on: February 22, 2011
First published on: May 1, 2003