May 24, 2008
What is Pseudoaddiction?
Thomas E. Quinn, MSN, RN, AOCN
This article first appeared in Pain Relief Connection Vol 2 #1, January 2004. “Pain Topics” and Pain Relief
Connection are services of MGH Cares About Pain Relief,
Pseudoaddiction is the term for an iatrogenic syndrome that appears to mimic behaviors that are commonly
believed to be associated with addiction. It may present in a patient with or without a history of or risk
factors for drug abuse or true addiction. It usually occurs with acute pain, including acute pain that is
overlaid on a chronic pain condition. It is characterized by a climate of distrust and conflict between the
patient and the care team related to the use of opioids for pain. Its etiology is pain that is inadequately
treated, leading to patient demands for opioid analgesia that are interpreted by the care team as being
excessive. The result is a progressive cycle of patient complaints of inadequate pain relief, sometimes
accompanied by exaggerated pain behaviors, and care team resistance to providing opioids, sometimes
compounded by avoidance and isolation of the patient.
In published case reports of pseudoaddiction, the patient’s report of pain is not believed, despite the presence
of a progressive disease or painful condition, or the potential for tolerance due to prior opioid use is not taken
into consideration by the care team. Inadequate analgesia is therefore inevitable due to either a dose that is
too low or a dosing interval that is too long. There is a tendency in such cases to provide even less analgesia,
further exacerbating the problem. In the case of Pseudoaddiction, “drug seeking” behavior is incorrectly
interpreted as evidence of addiction; it is more accurate it see it as “relief seeking” behavior.
The “treatment” for pseudoaddiction is to redesign the analgesic regimen so that analgesics are provided at
an appropriate dose and dosing interval. Ongoing and thorough pain assessment with corresponding
adjustment of dose (i.e., titrating to effect), as with any patient, is essential. Frank discussion with the patient
about the goals of pain treatment and the care team’s concerns are key to re-establishing a therapeutic
relationship between the patient and the care team. As David Weissman puts it, “pseudoaddiction is
something that we do to patients through our fears and misunderstanding of pain, pain treatment, and
addiction. . . Any time there is a suggestion, because of escalating pain behaviors, that a patient on opioids
may be ‘addicted,’ pseudoaddiction should be ruled out.”*
To learn more about pseudoaddiction, see (cited articles are available in Treadwell Library; Journal
of Palliative Medicine is also available free online via
on MGH computers)
1. Kowal N. What is the issue: pseudoaddiction or undertreatment of pain? Nursing
2. Porter-Williamson K, Heffernan E, Von Gunten CF. Pseudoaddiction. Journal of Palliative
3. Weissman DE, Haddox JD. Opioid pseudoaddiction--an iatrogenic syndrome. Pain
4. Weissman DE. Understanding pseudoaddiction Journal of Pain and Symptom Management
5. *Weissman DE. Pseudoaddiction.
, then click on ‘Fast Facts and Concepts’ and navigate
to #069, Pseudoaddiction). Accessed 18 Jan 2004.
MAGIC catalog at Treadwell Library: