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To the Editor.—Dr Portenoy and colleagues¹ call for greater understanding between pain specialists and addictionologists, something with which no one could disagree. More controversial, however, is the implication that opiate analgesics are proper and underused treatments for chronic pain, but that there needs to be an understanding of which patients have, or do not have, addiction liability. While the psychology of addiction is useful in understanding some reports from patients with chronic pain who report that opiates are helpful (comparable to some smokers' satisfaction with their habit), the real issue, with regard to chronic pain, is whether opiates are efficacious in the long run.²

It is common to find that patients with chronic pain improve in function, and often in subjective sense of pain, when weaned off opiates.³ Animal studies demonstrate that regular opiate use results in steadily diminishing analgesia, to the point that increased pain sensitivity occurs, a . . . [Full Text of this Article]