How it may affect treatment

Pseudoaddiction produces similar behaviors to drug addiction, including substance misuse and attempts to attain a drug or drugs. It can affect people who are not getting the correct treatment or management for their pain. However, it is not an official diagnostic term.

People first used the term pseudoaddiction in 1989 to describe a phenomenon that can occur in people with untreated or under-treated pain. Pseudoaddiction affects people with legitimate pain that pain medications such as opioids could help treat. It occurs either when they do not receive a prescription for proper pain medications or when the prescribed dosage of these medications is too low to manage their pain.

When people have chronic or severe pain that they cannot manage properly with their current prescription, they may misuse substances in an effort to reduce their pain. A healthcare professional may misinterpret substance misuse in people with pseudoaddiction as signs of an addiction.

As the term pseudoaddiction is not a diagnostic term in itself, its use may actually increase bias toward those who live with pain.

Keep reading to learn more about pseudoaddiction, including the causes, symptoms, and how to treat and manage the condition.

According to the Centers for Disease Control and Prevention (CDC), in 2019, some 20.4% of adults in the United States were living with chronic pain.

The percentage of people with untreated or poorly managed pain is unknown, but an estimated 83% of the global population have inadequate or no access to appropriate pain management medications.

It seems likely that a large proportion of people without access to pain medications or proper pain management will employ other methods, such as substance use, to reduce their pain. According to estimates, chronic noncancer-related pain affects about 48–60% of people who use drugs compared with 11–19% of the general population.

Untreated or poorly managed pain causes pseudoaddiction. The reasons as to why someone is not receiving adequate treatment is a more complex issue.

Many people globally do not have proper access, or any access, to pain medications or management. In some parts of the world, the resources to obtain or keep an adequate supply of appropriate pain medications are lacking. In other cases, people might not be able to afford pain medications or access healthcare professionals who prescribe them.

The stigma associated with certain pain medications, such as opioids, may also prevent someone from talking with a doctor about them or using them.

The signs and symptoms of pseudoaddiction tend to mimic those of addiction or conditions linked with addiction — in particular, opioid use disorder.

Common signs and symptoms of opioid use disorder and other types of substance addiction include:

  • a strong desire or craving to use opioids or other substances
  • taking more of a drug than the prescribed amount or taking it for longer than intended
  • Spending a significant amount of time getting or using the drugs or recovering from the effects they cause
  • taking desperate or unsafe measures to obtain opioids or other substances
  • having problems meeting obligations at home, school, or work
  • using opioids or substances despite experiencing recurring interpersonal, social, or work issues as a result
  • Reducing regular activities or giving them up because of substance use
  • using opioids or other substances in situations that could result in physical harm or danger to others
  • requiring increased amounts of the drugs to achieve the desired effect
  • undergoing withdrawal or taking opioids or other substances to avoid or reduce symptoms of withdrawal

It is possible to distinguish pseudoaddiction from true addiction if someone’s symptoms resolve once they receive proper treatment. However, currently, there is not enough scientific evidence to support pseudoaddiction as a separate diagnosis from addiction.

Can pseudoaddiction become addiction?

There is not much research or even anecdotal evidence regarding whether pseudoaddiction can become a true addiction. However, misusing prescription drugs or other substances, as some people with pseudoaddiction do, can cause addiction.

During the first 5 years after chronic pain develops, someone has a higher risk of developing new or unrelated substance use problems. This is particularly true for people with a history of substance use disorders.

People taking opioids for an extended period also have a much higher risk than others of misusing the medication or using illegal drugs. About 50% of people on long-term opioid therapy misuse the drug at some point, and the rates are even higher among people with a history of substance use disorders.

Some other factors can also influence the risk of someone becoming addicted to prescribed medications. These include:

  • levels of emotional distress
  • disability
  • concerns about addiction
  • Excessive scrutiny from others about medication use

The best way to manage and treat pseudoaddiction typically involves adequate pain control, most commonly in the form of prescription opioid medications to achieve an analgesic, or pain numbing, effect. Someone already taking opioid medications whose pain is still not under control may need to take higher or more frequent doses under the direction of a doctor.

People who are already taking opioid medications should review the possible negative effects of staying on the medication with their prescribing doctor to ensure that the benefits outweigh the risks. If someone decides that they need to stop taking pain medications, they should seek the advice of a doctor on ways to taper off the medications safely to minimize the impact of withdrawal symptoms.

People tapering off pain medications may benefit from support in the form of psychotherapy and other medications. The same is true for people who are attempting to reduce or stop medication misuse.

People with untreated or under-treated pain should talk with a doctor about ways to reduce or manage their pain.

Without proper treatment, moderate to severe pain can cause, contribute to, or increase the risk of:

  • high blood pressure
  • high cholesterol or blood lipid levels
  • adrenal exhaustion
  • scribe collapse
  • problems maintaining employment, social relationships, or daily obligations
  • feelings of hopelessness
  • sleeping problems
  • depression
  • anxiety
  • reduced quality of life
  • homelessness and poverty
  • suicide

Pseudoaddiction is a term that describes when someone with untreated or improperly managed pain displays substance misuse in a way that mimics addiction.

Pseudoaddiction is not a separate diagnosis from addiction.

People with untreated pain or pain that their prescribed medication does not manage should speak with a doctor about their options.

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