Background: The therapy of chronic pain of primarily drug addicted patients is a problem which has hitherto remained unresolved within the field of pain therapy. Synergistic effects of the prescribed medicine with additionally taken drugs or medicine which can lead to an unpredictable increase of effect of prescribed opioids are of special significance. When addiction and pain appear simultaneously medical aspects of the syndrome of addiction have to be implemented within the framework of coordinated therapy. In this case regular controls are to be taken; at the same time the treatment of cases of relapse must occur gradually. Not only is the final aim of this therapy abstinence but also a survival as healthy as possible. We don't ask more of the patient as he is able to perform, but we do ask everything which can be expected of him. In a treatment contract both therapist and patient agree on their individual tasks. With exemplary cases both the case history and the course of the therapy of four patients with simultaneous symptoms are illustrated.
Discussion: It becomes clear that the cooperative concept of therapy both with regard to pain as to addiction render an individual weighing of risks necessary. If the treatment of chronic pain is to be regarded as a primary goal then addicts can be treated in an institution devoted to the treatment of pain, providing there is a functioning cooperation with colleagues who are experienced in the treatment of addiction.
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