Dr David McGrath

Spine Physician

MB BS (Hons) FAFOM, RACP, FAFMM
Master of Pain Medicine

These terms are mostly used in the context of drugs, with potential for social abuse. The opiate class of drugs, prescribed for pain are the most prominant.

Typically we prescribe
1.Codeine
2.Dextropropoxyphene
3.Oxycodone
4.Morphine
5.Fentanyl
6.Methadone
7.Buprenorphine
8.Tramadol

These drugs come in several preparations
1.Oral tablets
2.Rectal suppositories
3.Skin patches

The delivery system, also allows for, fast or slow uptake into the body. (inversely short or long duration)

Dependence means, that there is no or low, quality of life without the use of the drug
Tolerance means, that an increasing quantity is needed, for the same therapeutic effect
Addiction means, pain control is immaterial or minor, and other psychic effects dominate.

Dependence is of no great concern,
1.Except for the social and financial costs.
2.Other more successful treatments, may be neglected

Tolerance is also of no great concern,
1. The dosage typical increases
2. The type or delivery system may need to change

Opioid- Induced Hyperalgesia
1. Increased pain sensitivity
2. The quantity may need to be reduced or nature of the drug may need to be changed

Addiction is of social and medical concern
1.There is a fundamental diagnostic error (sometimes through deliberate deception)
2.The true disorder escapes attention and effective intervention
3.There is a waste of medical and social resources
4.There is tremendous potential for self harm