疼痛药物的成瘾，物理依赖性和耐受性

There is a difference between瘾, physical dependence, and tolerance topain medication。我们每个人都必须了解差异。

许多患有慢性疼痛条件（包括某些类型的关节炎）的人都是规定的止痛药。他们的医疗状况决定了这种药物的需要 - 这就是为什么它作为其治疗计划的一部分被规定。然而，如果您注意新闻，那些合理规定的止痛药的人被滥用者群。我们可以轻松理解开发的方式。毕竟，有一种流行病阿片类药滥用在美国毒品据说开抗生素d. Add to that a celebrity dying from a drug overdose and the anti-drug campaigns hit a fever pitch.

Each of the aforementioned problems is a legitimate concern. But, so is the disregard for people (e.g., chronic pain patients) who legitimately need pain medication to function and have some quality of life. Their plight cannot be minimized while the urgency of other matters is dealt with. This realization has largely been lost because too many people do not understand the difference between addiction, physical dependence, and tolerance. We cannot blur the lines between these three factors and expect to solve problems related to drug use and abuse. It is the first step we all must take—understanding the terminology.

什么是成瘾？

The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definition of addiction as it relates to the use of opioids for the treatment of pain:

成瘾是一种主要，慢性，神经生物学疾病，具有影响其开发和表现的遗传，心理社会和环境因素。

What Is Physical Dependence?

The American Society of Addiction Medicine (ASAM), the American Academy of Pain Medicine (AAPM), and the American Pain Society (APS) recognize the following definition of physical dependence:

物理依赖性是一种适应状态，其表现为特定的药物类withdrawal syndromethat can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

What Is Tolerance?

美国成瘾医学学会（ASAM），美国止痛药学院（AAPM）和美国痛苦社会（APS）认识到以下对耐受性的定义：

Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution (i.e., diminishing or lessening) of one or more of the drug's effects over time.

That said, most pain medicine and addiction specialists concur that chronic pain patients treated longterm with opioid drugs usually do develop physical dependence. Some patients will develop tolerance. But, usually, this group of patients does not develop an addiction. The actual risk of addiction is considered unknown and not predictable, but it is likely related to several factors, including genetic predisposition.

瘾itself is a primary chronic disease. Exposure to drugs is just one factor in its development. In fact, in most cases, exposure to drugs that can stimulate the brain's reward center do not produce addiction.

Characteristic Features and Behaviors

Impaired control, craving, and compulsive use of the drug, as well as continued use of the drug despite negative physical, mental, or social consequences, are considered characteristic features of addiction. But, it can be a bit more complicated than simply recognizing the presence of those features. The same features could be related to inadequate pain relief. A doctor must be able to exercise their judgment and to discern between addiction and another cause.

There are specific behaviors that point to the possibility of addiction. Those behaviors include:

• Not adhering to the prescribed schedule for the drug
• Taking more than one dose at a time
• 重复报告被盗或丢失的药物
• 医生购物（从一个以上的医生那里获得药物）
• Isolation (wanting time alone)
• 另外使用非规定的精神活性药物
• 利用止痛药进行镇静，中毒，促进能量，或降低焦虑水平
• 要求某种制剂或药物给药途径
• 避免在非阿片类药物治疗方案中或不感兴趣

成瘾清楚地与潜在的严重，甚至致命，后果相关联。另一方面，物理依赖被认为身体对慢性或继续使用某些药物的正常响应 - 而不仅仅是阿片类药物止痛药。例如，皮质类固醇可以发生物理依赖性，抗抑郁药，β-阻滞剂，以及其他药物未被视为上瘾。如果可能停止可能与物理依赖性相关的药物，则该药物应逐渐变细，以避免戒断症状（例如，泼尼松逐渐变细）。

公差甚至有点棘手理解。耐受可能对药物的所需效果可能发生，但也可能发生不期望的效果。耐受性也是可变的，以不同的效果的不同速率发生。使用阿片类药物作为一个例子，对镇痛作用的耐受性比呼吸抑郁症更慢。

底线

瘾is mostly a behavioral disorder, although it can overlap with physical dependence. Typically, addiction involves using the drug despite negative consequences, craving the drug even when not in physical pain, and using it for reasons other than the prescribed indication. Physical dependence is evident when someone develops a tolerance to a drug or if one would experience withdrawal symptoms from stopping the drug suddenly. Tolerance is present when the same dose does not garner the same result, thereby requiring higher doses to achieve the desired result. In and of itself, physical dependence does not mean that there is addiction, but it may accompany addiction when there is addiction.