Definitions Relevant to use of Opioid Analgesics in Fibromyalgia

Addiction: Addiction is a neurobehavioral syndrome with generic and environmental influences that results in psychological dependence on the use of substances for their psychic effects and is characterized by compulsive use despite harm. Addiction may also be referred to by terms such as "drug dependence and "psychological dependence. Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and should not be considered addiction. 

Analgesic Tolerance: Analgesic tolerance is the need to increase the dose of opioid to achieve the same level of analgesia. Analgesic tolerance may or may not be evident during opioid treatment and does not equate with addiction. 

Chronic Pain: A pain state which is persistent and in which the cause of the pain cannot be removed or otherwise treated. Chronic pain may be associated with a long-term incurable or intractable medical condition or disease.

Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. 

Physical Dependence: Physical dependence on a controlled substance is a physiologic state of neuroadaptation which is characterized by the emergence of a withdrawal syndrome if drug use is stopped or decreased abruptly, or if an antagonist is administered. Physical dependence is an expected result of opioid use. Physical dependence, by itself, does not equate with addiction. 

Pseudoaddiction: A pattern of drug seeking behavior of pain patients, who are receiving inadequate pain management, that can be mistaken for addiction. 

Substance Abuse: Substance abuse is the use of any substance(s) for non-therapeutic purposes; or use of medication for purposes other than those for which it is prescribed. 

Tolerance: Tolerance is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce the same effect or a reduced effect is observed with a constant dose.

 
References 

1. Acute Pain Management Guideline Panel. Acute Pain.Management; Operative or Medical Procedures and Trauma Clinical Practice Guideline. AHCPR Publication No. 92-0032. Rockville, Md. Agency for Health Care Policy and Research. U.S. Department of Health and Human Resources, Public Health Service. February 1992. 

2. Jacox A, Carr DB, Payne R, et al Management of Cancer Pain. Clinical Practice Guidelines No. 9. AHCPR Publication No. 94-0592 Rockville, Md. Agency for Health Cue Policy and Research. U.S. Department of Health and Human Resources Public Health Service. Much 1994.