Pain, physical dependence and pseudoaddiction: Redefining addiction for 'nice' people?

Backgound: The undertreatment of pain has increasingly been framed as both a public health problem and a human rights issue. The application of rights-based discourses to the field of pain management has provided an important means of critiquing "opiophobia" amongst healthcare professionals and challenging current criminal-legal and regulatory sanctions on the distribution of opiate medications. This movement would therefore appear to align with harm reduction advocacy and longstanding criticisms of international drug policies. However, discourses on pain management rest on moral as well as medical assumptions about who has pain and who needs drugs. Methods: In this paper, we critically examine discourses on pain management and addiction exemplified in academic and clinical literature produced by and for physicians providing guidance on the provision of opiates for the relief of chronic pain. Results: Our analysis reveals that discourses on pain management and the right to pain relief reify distinctions between the 'deserving pain patient' and the 'undeserving addict', serving both to further stigmatise people labelled as 'addicts' and delegitimise claims to pain they might voice. Conclusion: Present efforts to secure access to pain relief as a human right are likely to undermine, rather than advance, the rights of so-called 'drug addicts'. Crown Copyright (C) 2008 Published by Elsevier B.V. All rights reserved.