Pseudoaddictive behavior

I learned about pseudoaddictive behavior at a pain management class a few months ago. Because I've been reading the new CDC opioid management guidelines, I've been pondering it again.

What is it? It's when people are undermedicated for pain so they start acting like drug seekers, only they're actually seeking drugs because they're in pain. Here is the common scenario presented in the class.

A patient gets pain medication every 4 hours, say. It is not a sufficient dose to last that whole time, so after 3 hours, he starts hurting and looking at the clock. He probably knows that he can have medication 30 minutes before or after the due time, so after 3.5 hours he's on the call light. The nurse is quickly irritated by this behavior and, often, reacts by withholding it. By the time the patient gets it, he is in really severe pain, so now he is going to be anxious about the pain returning and not being able to get his medication when he needs it.

Guess what? That's going to cause behavior that looks exactly like that of someone who just wants pain medication. This patient will ask earlier and earlier and get more and more anxious. He may insist on talking to the doctor and become angry and hostile. But he isn't "just a drug seeker." He's in pain and inadequately medicated.

The problem here is that in today's opio-phobic environment, anyone who asks for pain medication sets off alarm sirens in medical professionals. Oh my God, this person asks for his oxycodone every 3.5 hours! He's obviously addicted! No. It isn't obvious.

It's not hard to differentiate addictive from pseudoaddictive behavior. Increase the pain medication. If the patient is just drug-seeking, the behavior will not change. If he really is inadequately medicated, he will stop the pseudoaddictive behavior. But we can't help if we don't recognize this pattern and the possible reasons behind it.