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Managing Pain in Patients with a History of a Substance Use Disorder: Challenges and Opportunities 

Managing Pain in Patients with a History of a Substance Use Disorder: Challenges and Opportunities
Chapter:
Managing Pain in Patients with a History of a Substance Use Disorder: Challenges and Opportunities
Author(s):

Martin D. Cheatle

DOI:
10.1093/med/9780199981830.003.0008
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date: 31 May 2020

Patients with chronic pain tend to be complex and can present with multiple comorbidities, including anxiety, depression, functional disabilities, and substance misuse or abuse. The burgeoning rate of prescription opioid misuse and abuse and opioid-related fatalities has generated a great deal of scholarly activity on understanding the etiology of opioid misuse/abuse and developing risk assessment and mitigation strategies to curb this public health crisis. Balancing effective pain management and reducing the risk of opioid misuse/abuse and diversion can be a daunting endeavor, as is controlling pain in patients with pain and concomitant substance use disorders. This chapter provides an overview of the prevalence of opioid misuse/abuse in patients with chronic pain. It covers pharmacologic and nonpharmacologic therapies for patients with pain and co-occurring opioid use disorder and also discusses the challenges and opportunities to improve pain care and reduce misuse and abuse of opioids.

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