Sudo meaning medical6/24/2023 Pseudoaddiction (with “pseudo-” from Latin meaning “fake,” “not real,” was originally introduced and defined by Weissman and Haddox in 1989 as an “iatrogenic syndrome that mimics the behavioral symptoms of addiction” in patients receiving inadequate doses of opioids for pain. Pseudoaddiction, the subject of this review, is a clinical concept that has been influential as a diagnosis in clinical practice and the medical literature to indicate that under-treatment of pain, rather than risk of addiction with opioids, should be the primary clinical concern. While the origins of these trends are attributable to the recognition of pain as a significant, undertreated public health problem, a growing emphasis on opioids as the major, front-line treatment of choice for pain has gone hand in hand with reducing physicians’ fears of opioids causing or contributing to addiction. By the end of the last decade, Americans, although just 4 % of the world’s population, were consuming 80 % of the global opioid supply and 99 % of the world’s hydrocodone supply. From 2000 to 2009, opioids dispensed from US outpatient pharmacies rose from 174.1 million to 256.9 million doses. Accordingly, massive increases in US expenditures for prescription pharmaceuticals (from $12 billion in 1980 to $263 billion in 2011 ) have been driven in part by increases in opioid prescriptions and consumption. This shift has been attributed to various trends and organizational initiatives within health care that have (1) increased the prioritization and emphasis on the diagnosis of pain, relative to other medical issues (e.g., “pain is the fifth vital sign”), and (2) the treatment of pain with opioid analgesics as opposed to other modalities that have reputations of being less clinically efficacious and/or less cost-effective than opioids. Over the last 20 years, US health care has undergone a major shift in attitudes and clinical practice involving increased prescribing of opioids to patients with different causes and levels of acute and chronic pain. Future studies should examine whether acceptance of pseudoaddiction has complicated accurate pain assessment and treatment, and whether it has contributed to or reflected medical-cultural shifts that produced the iatrogenic opioid addiction epidemic. Nevertheless, the term has been accepted and proliferated in the literature as a justification for opioid therapy for non-terminal pain in patients who may appear to be addicted but should not, from the perspective of pseudoaddiction, be diagnosed with addiction. Empirical evidence supporting pseudoaddiction as a diagnosis distinct from addiction has not emerged. In contrast, six articles, none with pharmaceutical support, questioned pseudoaddiction as a clinical construct. These papers described pseudoaddiction as an iatrogenic disease resulting from withholding opioids for pain that can be diagnosed, prevented, and treated with more aggressive opioid treatment. Twelve of these articles, including all four that acknowledged pharmaceutical funding, were proponents of pseudoaddiction. Only 18 of these articles contributed to or questioned pseudoaddiction from an anecdotal or theoretical standpoint, and none empirically tested or confirmed its existence. By 2014, pseudoaddiction was discussed in 224 articles. This investigative review searched Medline articles containing the term “pseudoaddiction” to determine its footprint in the literature with a focus on how it has been characterized and empirically validated. Pseudoaddiction, a concept coined in 1989, has frequently been cited to indicate that under-treatment of pain, rather than addiction, is the more pressing and authentic clinical problem in opioid-seeking patients. Tremendous growth in opioid prescribing over two decades in the USA has correlated with proportional increases in diversion, addiction, and overdose deaths.
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