GUIDELINES FOR THE USE OF OPIOIDS IN THE TREATMENT OF CHRONIC, NON-CANCER PAIN

For the purposes of this document the following terms shall have the following definitions:

Addiction

is a disease process involving use of opioid(s) wherein there is a loss of control, compulsive use, and continued use despite adverse social, physical, psychological, occupational, or economic consequences.

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.

Physical dependence

is a physiologic state of adaptation to a specific opioid(s) characterized by the emergence of a withdrawal syndrome during abstinence, which may be relieved in total or in part by re-administration of the substance. Physical dependence is a predictable sequelae [sic] of regular, legitimate opioid or benzodiazepine use, and does not equate with addiction.

Tolerance

is a state resulting from regular use of opioid(s) in which an increased dose of the substance is needed to produce the desired effect. Tolerance may be a predictable sequelae [sic] of opiate use and does not imply addiction.

Withdrawal syndrome

is a specific constellation of signs and symptoms due to the abrupt cessation of, or reduction in, a regularly administered dose of opioid(s).

Opioid withdrawal

is characterized by three or more of the following symptoms that develop within hours to several days after abrupt cessation of the substance: (a) dysphoric mood, (b) nausea and vomiting, (c) muscle aches and abdominal cramps, (d) lacrimation or rhinorrhea, (e) pupillary dilation, piloerection, or sweating, (f) diarrhea, (g) yawning, (h) fever, (i) insomnia.

Acute pain

is the normal, predicted physiological response to an adverse (noxious) chemical, thermal, or mechanical stimulus. Acute pain is generally time limited and is historically responsive to opioid therapy, among other therapies.

Chronic pain

is persistent or episodic pain of a duration or intensity that adversely affects the function or well-being of the patient, attributable to any non-malignant etiology.