The Early Diagnosis of Iatrogenic Opioid Dependence Syndrome

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Abstract
The Opioid Dependence Syndrome is defined in terms of a pattern of opioid drug use which includes evidence of both physical and psychological dependence. While nearly all individuals receiving long‐term opioid analgesics for chronic pain will develop physical dependence on opioids, only a small proportion will develop the “pathological” Opioid Dependence Syndrome. Some possible attributes which may differentiate between those who are, and those who are not, likely to develop “pathological” opioid dependence are listed, as are the behaviour patterns which, if observed to develop in patients already receiving long‐term opioid analgesia, should raise one ‘s suspicions of its diagnosis. The problems of psychological dependence, such as maladaptive drug‐seeking behaviour, are discussed and the management of the opioid dependence syndrome, with special reference to those patients who have developed it iatrogenically, is outlined. An algorithm for the management of recurrent acute/chronic pain is proposed.

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