There have been few studies of the psychiatric characteristics of
analgesics addiction. The physician's perceptions that patients were addicted to
analgesics might be partially attributable to frustration with poor response to treatment. In this retrospective study, we evaluated the medical records of 20 subjects (15 male and 5 female) who were perceived as having addiction to
meperidine by general physicians. The most common medical diagnosis among these patients was
chronic pancreatitis (7/20). Among them, five had a past history of suicide attempt and three had self-injury behavior during the index admission. The fact that subjects were perceived as being addicted might be attributable to a vicious cycle of the following factors: 1) chronic
intractable pain; 2) poor staff-patient relationship; 3) lower pain threshold or tolerance due to anxiety or depression; 4) patients with a history or tendency of
substance abuse; 5) placebo use and inadequate
analgesics regimen. The findings of this study suggest that the importance of the following diagnostic and treatment procedures in these patients: 1) suicide risk should be evaluated; 2) comorbid
psychiatric diseases should be treated; 3) factors that cause a vicious cycle in
pain control should be identified; 4) misconceptions of
opiate analgesics among medical staff should be discussed; 5) poor staff-patient relationship should be managed aggressively; and 6) "addiction" is a critical diagnosis that should be avoided if possible.