Addictive Disorders, Addiction Medicine and Pharmaceuticals

Biography

Biography: Roland Worz

Abstract

Both NSAIDs and opioids are valuable substances in the treatment of acute pain. However, their prolonged administration, extending over a few weeks implies the risk of severe complications. In the case of acute pain, the model of nociception is usually used in assessment, explanation, and therapy. In contrast, chronic pain is only in a part of the cases result of injury or surgery. Therefore, the established definition of chronic pain as “any pain that persists beyond the anticipated time of healing” is misleading. It is suggesting the existence of nociceptive, neuroplastic, and neoplastic mechanisms with the consequence of analgesic drug administration. In the majority of chronic pain syndromes, there is a multifactorial etiopathogenesis with biological, psychological, and social influences. For such patients, the complexity theory might be a more appropriate conceptual framework than conventional, sequential models of nociception. In the case of simple pain states, the link between stimulus and pain experience is linear, whereas in complex pain conditions there are multiple associations among elements, between which there may be nonlinear and nondeterministic relations. The terms causal sequence and network illustrate the fundamental differences. In addition, clinical pain is often the result of multiple chronification factors, which contribute to complexity. The origin and development of analgesic drug abuse are multifactorial and complex, too. In the case of chronic pain, there are often associations with depressive disorders, different anxiety syndromes, posttraumatic stress disorder, and other psychiatric conditions. In all these disorders, pain experiences may be components of the disease. Complexities can be analyzed and controlled. In the case of chronic pain, the stimulus-response-scheme pain-analgesic drug administration is not appropriate and often dangerous. Prolonged use of analgesic drugs is only appropriate in exceptions. If necessary, a systematic, patient-centered management with regular controls is adequate. The assessment of biography, psychological features and functioning in family and profession is useful. The dangers of addiction, diversion, abuse, and misuse should be carefully observed in regular therapeutic intervals. Prevention is better than cure!