A patient with addictive disorder is a tremendous challenge in pain management. Some of the major dilemmas the clinician has in treating pain in a patient with history of substance use or abuse include the potential consequences of not achieving the proper balance between undertreating or overtreating pain, the risks of precipitating worsening addictive behaviors with the utilization of opiates, and the medicolegal implications that may be associated with opioid use. In the next sections, treatment of pain in this population according to whether pain is acute or chronic is discussed.
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