Iatrogenic addiction in patients treated for acute or subacute pain: a systematic review

Abstract

We conducted a systematic review of the literature on the evidence for iatrogenic addiction in patients treated for acute and subacute pain. Literature searches yielded 1,943 articles, 53 of which were reviewed in detail, and 41 of which met criteria for inclusion in the review of iatrogenic addiction. Two authors independently reviewed and summarized the findings of each article. Discrepancies of ratings were resolved by discussion. We identified no randomized trials or comparative longitudinal studies. The results of nine studies of low methodological quality suggest conflicting findings. This manuscript discusses some possible mechanisms of iatrogenic addiction and concludes with suggestions for methodologically stronger studies to provide more definitive data regarding the evidence for or against iatrogenic addiction in patients treated for acute and subacute pain. The systematic review of the literature could not adequately answer the study questions; thus, it is not known whether the risk for iatrogenic addiction among patients treated with opioids for acute or subacute pain is relatively high (> 10 percent) or low (< 0.1 percent).