Pseudoaddiction
Pseudoaddiction refers to drug-seeking behaviors that resemble addiction but arise primarily due to inadequate pain management. Individuals experiencing chronic or acute pain may display behaviors typical of addiction, such as requesting higher doses of medication or demonstrating urgency in obtaining pain relief. This phenomenon occurs when patients are not receiving sufficient pain relief, leading them to seek more medication to alleviate their discomfort. Pseudoaddiction was first identified in 1989 and can involve phases of inadequate treatment, escalating demands for pain relief, and growing mistrust between patients and healthcare providers.
It is crucial to differentiate pseudoaddiction from true addiction, as the former is driven by a genuine need for adequate pain management. Notably, if a patient’s drug-seeking behaviors cease once they receive appropriate pain relief, it indicates pseudoaddiction rather than addiction. Treatment involves ensuring that patients receive adequate and effective pain relief, which can be challenging in the current healthcare climate, particularly amid the opioid crisis. A trusting relationship between patients and providers is essential, especially for older adults who may require different considerations regarding medication efficacy and dosage. Understanding and addressing pseudoaddiction is vital for preventing the escalation into substance use disorders while ensuring that patients' pain is managed appropriately.
Pseudoaddiction
DEFINITION: A pseudoaddiction is a drug-seeking behavior that mimics addiction. It occurs in persons who are not receiving adequate pain relief, and it indicates mismanagement of pain relief treatment.
Introduction
People experience pain in many ways and for many reasons, ranging from acute pain from injuries or surgery to chronic pain from long-term diseases such as arthritis. Healthcare practitioners provide pain-relieving medications, but these medications do not work equally well for each person.
A dosage of a pain relief medication that may work for one person may be either inadequate or overwhelming for another person. In addition, certain types of pain relievers work better for some people than for others, even in persons with the same condition. For example, extra-strength acetaminophen may be sufficient for one person, while for another, opioids may be needed to adequately relieve pain. Sometimes, the level of pain relief can depend on the age of the person or on the amount of pain-relieving medication taken previously.
Pseudoaddiction was first described in 1989 in the case of a seventeen-year-old who had pain related to leukemia. Because the patient’s pain was inadequately treated, the patient began exhibiting addictive behaviors. The patient’s progression to pseudoaddiction was traced through phases, which are still used to describe pseudoaddiction. The phases are inadequate pain relief medications, demands by the patient for more painkillers and for more frequent doses of painkillers (with accompanying behavior changes that attempt to convince caregivers that more pain relief is necessary), and mistrust between patient and their healthcare team about the severity of pain and the necessity of pain relief.
Pseudoaddiction versus Addiction
Patients who are not receiving enough medication to alleviate their pain may begin to exhibit drug-seeking behaviors that mimic addiction. These behaviors include focusing on getting medication or watching the clock to monitor when the next dose of pain medication will be available. Patients also may moan or grimace in a way that seems excessive, may be deceptive about their use of painkillers, and might even seek illicit drugs for pain relief.
Pseudoaddicts are not addicted to the drug in the common sense; they are simply seeking adequate pain relief. Because their behavior may seem addictive to a person not familiar with the case, this condition is termed pseudoaddiction. One can determine if a patient is experiencing pseudoaddiction or is truly addicted by noticing if the drug-seeking behaviors cease once the patient receives adequate pain medication. However, no official, evidence-based criteria exist for diagnosing pseudoaddiction and determining the difference between this condition and true addiction. Amid the opioid epidemic, this distinction in patient care is both critical and difficult.
Treating Pseudoaddiction
Recognizing and treating pseudoaddiction before it evolves into addiction is important in limiting substance use disorders. The first and most important activity in treating pseudoaddiction is to provide the patient with enough medication to adequately relieve pain. This may be difficult because, by the time the patient is exhibiting drug-seeking behavior, healthcare providers may distrust the patient enough to refuse to provide any more pain medication. Providers may need to be convinced to attempt a trial of providing pain relief to the point that the patient actually feels relief and stops exhibiting this type of behavior before a relationship of trust can once again be attempted.
Treatment of pseudoaddiction in older adults can be particularly difficult. Though providers may believe that the dosage and frequency of pain-relieving medication are more than adequate, they should consider that aging organs might not be able to process medications to the point of providing relief. Thus, the patient will still experience pain even with frequent or high doses of medication. A movement has begun among health professionals treating pain in older adults to ensure that doses of pain relief are adequate for the particular patient and not based on suggested dosages only. The movement encourages a relationship of trust in which the provider believes the patient if the patient still complains of pain.
Bibliography
Huizen, Jennifer. "What to Know About Pseudoaddiction." Medical News Today, 3 Mar. 2023, www.medicalnewstoday.com/articles/pseudoaddiction. Accessed 20 Sept. 2024.
Sees, K. L., and H. W. Clark. “Opioid Use in the Treatment of Chronic Pain: Assessment of Addiction.” Journal of Pain and Symptom Management, vol. 8, 1993, pp. 257–64.
Turk, D. C., H. D. Wilson, and A. Cahana. “Treatment of Chronic Non-Cancer Pain.” Lancet, vol. 377, 2011, pp. 2226–35.
Weissman, D. E., and J. D. Haddox. “Opioid Pseudoaddiction: An Iatrogenic Syndrome.” Pain, vol. 36, 1989, pp. 363–66.
Weissman, David E., and Sean Marks. "Pseudoaddiction." Palliative Care Network of Wisconsin, 29 Jan. 2019, www.mypcnow.org/fast-fact/pseudoaddiction. Accessed 20 Sept. 2024.