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Heroin Addiction and Related Clinical Problems: 2008, 10, 3 (pages: 13 - 24)

Pseudo-Addiction: The Illustrative Case of Howard Hughes

Tennant F.

Summary: While the need for chronic pain treatment is evident by epidemiologic surveys from many countries, countless persons continue needless suffering due to lack of pain treatment. One is a bias against opioid drugs, and the false belief that persons who take opioids are “addicts”. Modern definitions essentially relegate the term “addict” to persons who take opioids for non-pain purposes. The term “pseudo-addiction” is now the term properly used for those persons who seek pain relief by patronizing a variety of sources to obtain opioids because they lack a regular, medical source of treatment with opioids. Perhaps the most famous “pseudo-addict” was Howard Hughes. He was involved in a plane crash in 1946 and suffered severe chronic pain as a result of facial and neck fractures and third degree burns of the upper torso. His subsequent post-trauma neuropathies are now commonly referred to as Reflex Sympathetic Dystrophy. They were so severe that he often could not brush his teeth, comb his hair, shave, or wear clothes or shoes. He survived 30 years taking about 200 mg equivalent of morphine a day for pain control. At this time the author is treating a cohort of severe, chronic pain patients who have taken high, daily opioid dosages for 20 to 30 years. As did Howard Hughes, these patients lead high quality, productive lives despite high dose opioid treatment. Severe, chronic pain, per se, and unrelated to its underlying cause, has life shortening and debilitating complications that are caused by uncontrolled electrical conduction, excess sympathetic discharge in the autonomic nervous systems, and excess pituitary-adrenal hormone secretions. Pseudo-addicts are easy to clinically differentiate from bonafide opioid addicts and treatment facilities should differentiate between the two. We need a world wide humane movement to provide life-time, opioid, medical management for persons afflicted with severe, chronic pain that can only be controlled by opioid drugs.