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January 7, 1998

Pain Management and Chemical Dependency

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(1):17-18. doi:10.1001/jama.279.1.17

To the Editor.—Dr Portenoy and colleagues1are correct that major gaps exist in the clinical management of acute and chronic pain and the recognition of chemical dependency. The history of opioid use has been characterized by a wide range of views that previously suggested rampant overprescription, but more recent views embrace a model that pain has been grossly undertreated and that unfounded fears of addiction have interfered with effective pain control.2 In the face of this conflict, the practicing physician often is frustrated accommodating literature that validates more liberal prescribing policies for opioids but at the same time facing practical clinical difficulties and personal uneasiness in prescribing long-term administration of opioids for individual patients.