Meperidine addiction or treatment frustration?

There have been few studies of the psychiatric characteristics of analgesic s addiction. The physician's perceptions that patients were addicted to ana lgesics might be partially attributable to frustration with poor response t o treatment. In this retrospective study, we evaluated the medical records of 20 subjects (15 male and 5 female) who were perceived as having addictio n to meperidine by general physicians. The most common medical diagnosis am ong these patients was chronic pancreatitis (7/20). Among them, five had a past history of suicide attempt and three had self-injury behavior during t he index admission. The fact that subjects were perceived as being addicted might be attributable to a vicious cycle of the following factors: 1) chro nic intractable pain; 2) poor staff-patient relationship; 3) lower pain thr eshold or tolerance due to anxiety or depression; 4) patients with a histor y or tendency of substance abuse; 5) placebo use and inadequate analgesics regimen. The findings of this study suggest that the importance of the foll owing diagnostic and treatment procedures in these patients: 1) suicide ris k should be evaluated; 2) cormorbid 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 he disc ussed; 5) poor staff-patient relationship should be managed aggressively; a nd 6) "addiction" is a critical diagnosis that should be avoided if possibl e. (C) 2001 Elsevier Science Loci All rights reserved.