We report 8 in-patients with nonmalignant
chronic pain (main diagnosis: 7 somatoform
pain disorders, 1
eating disorder) and with abuse of
opioid therapy, which we have treated within 2 years in an tertiary centre. In all patients the inefficacy of
opioids with regard to
pain symptomatology could be demonstrated. Because the ICD-10 criteria of addiction cannot be fully applied to patients under
opioid therapy because of
chronic pain we suggest as criteria the intake of
opioids because of positive psychotropic effects, the demand of high dosage of short acting
opioids with inefficacy of similar long acting
opioids dosage, the uncontrolled raising of dosage with illegal procurement and reluctance of the patient to stop
opioid therapy because of proved inefficacy of
pain control. These criteria applied 4% of all in-patients treated because of
chronic pain and 30% of all in patients with somatoform
pain disorder of our interdisciplinary unit fulfilled within two years the criteria of
opioid therapy abuse. The risk of abuse of
opioid therapy described in
pain therapy literature for patients with
substance abuse is also relevant for patients with somatoform
pain disorder. Therefore a qualified psychotherapeutic evaluation before starting an
opioid therapy for nonmalignant
pain in order to exclude a somatoform
pain disorder or to assess a substance dependency is mandatory. Patients with somatoform
pain disorder should be treated with
opioids only in clinical studies. A prior or present history of
substance abuse given chronic
opioid therapy for nonmalignant
pain should only be performed in close cooperation of addiction- and
pain therapists.