Table 1.
Pain and Addiction Terminology*
| Term | Definition |
|---|---|
| Physical dependence | Normal physiologic adaptation defined as the development of withdrawal or abstinence syndrome with abrupt dose reduction or administration of an antagonist |
| Tolerance | Normal neurobiological event characterized by the need to increase the dose over time to obtain the original effect |
| Cross-tolerance | Normal neurobiological event of tolerance to effects of medication within the same class |
| Substance (opioid) dependence (addiction) | Chronic neurobiological disorder defined as a pattern of maladaptive behaviors, including loss of control over use, craving and preoccupation with nontherapeutic use, and continued use despite harm resulting from use with or without physical dependence or tolerance |
| Pseudoaddiction | Behavioral changes in patients that seem similar to those in patients with opioid dependence or addiction but are secondary to inadequate pain control |
| Drug-seeking behaviors | Directed or concerted efforts on the part of the patient to obtain opioid medication or to ensure an adequate medication supply; may be an appropriate response to inadequately treated pain |
| Therapeutic dependence | Patients with adequate pain relief may demonstrate drug-seeking behaviors because they fear not only the reemergence of pain but perhaps also the emergence of withdrawal symptoms |
| Pseudo-opioid resistance | Adequate pain relief continue to report persistent severe pain to prevent reduction in current opioid analgesic dose |
| Opioid-induced hyperalgesia | A neuroplastic change in pain perception resulting in an increase in pain sensitivity to painful stimuli, thereby decreasing the analgesic effects of opioids |