Opioid pseudoaddiction — an iatrogenic syndrome

TLDR

Pseudoaddiction is an iatrogenic syndrome that arises when inadequate pain management leads to a progression of three phases—insufficient analgesic prescription, escalating patient demands, and mistrust—illustrated by a 17‑year‑old leukemia patient with chest‑wall pain. The authors introduce the term pseudoaddiction to describe abnormal behavior that develops directly from insufficient pain control. Treatment involves building trust between patient and clinicians and delivering timely, appropriate analgesics to manage pain. In this case, inadequate pain treatment produced behavioral changes resembling opioid addiction.

Abstract

A case is presented of a 17-year-old with leukemia, pneumonia and chest-wall pain. Inadequate treatment of the patient's pain led to behavioral changes similar to those seen with idiopathic opioid psychologic dependence (addiction). The term pseudoaddiction is introduced to describe the iatrogenic syndrome of abnormal behavior developing as a direct consequence of inadequate pain management. The natural history of pseudoaddiction includes progression through 3 characteristic phases including: (1) inadequate prescription of analgesics to meet the primary pain stimulus, (2) escalation of analgesic demands by the patient associated with behavioral changes to convince others of the pain's severity, and (3) a crisis of mistrust between the patient and the health care team. Treatment strategies include establishing trust between the patient and the health care team and providing appropriate and timely analgesics to control the patient's level of pain.