This talk aims to make a distinction between the two growing epidemics in medicine and more especially in psychiatry-opioid dependence and functional pain syndromes (FPS). The distinction has been blurred in current literature, and often, patients with FPS are labelled addicts. Opioid addicts are not treated for the FPS which perpetuate their addiction. More importantly, the onset of both these syndromes is often iatrogenic in nature. Genetics, epigenetics, early childhood trauma and rejection, personality disorders as well as clinical depression and anxiety syndromes all have an intersecting role in this group of patients which makes it crucial for psychiatrists and registrars to be aware of how to recognise and treat them. The Durban pain clinic runs a multidisciplinary team approach towards helping patients with FPS and opioid addictions using the currently available information of the possible pathophysiology of the FPS group of diagnosis, and the basis of this programme will be elaborated and put forward as an alternative to what’s currently available. The clinic with the aid of an unrestricted grant from Cipla, South Africa, is putting together a think tank to come up with guidelines to be published which can be used nationally to manage patients with FPS. The talk proposes these guidelines to the audience and hopes to engender an awareness and level of interest in the field so that the word can be spread amongst other specialties and colleagues. There is no role for opioids in the management of chronic pain syndromes.

中文翻译：

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慢性疼痛，阿片类药物和成瘾

本演讲的目的是区分两种正在增长的医学流行病，尤其是在精神科，阿片类药物依赖和功能性疼痛综合征（FPS）中。在现有文献中，这种区分变得模糊不清，而且经常将FPS患者称为成瘾者。阿片类药物成瘾者未接受永久性成瘾的FPS治疗。更重要的是，这两种综合征的发病本质上通常是医源性的。遗传学，表观遗传学，儿童早期创伤和排斥反应，人格障碍以及临床抑郁症和焦虑症候群在这组患者中均起着交叉作用，这使得精神科医生和注册服务商意识到如何识别和治疗它们至关重要。德班疼痛诊所采用多学科团队方法，利用FPS诊断组可能的病理生理学的当前可用信息来帮助FPS和阿片类药物成瘾的患者，并将详细阐述和提出该计划的基础，以替代FPS和阿片类药物成瘾者。目前可用。该诊所在南非Cipla的无限制拨款的帮助下，正在组建一个智囊团，以提出即将出版的指南，该指南可在全国范围内用于治疗FPS患者。演讲向听众提出了这些指导方针，并希望引起人们对该领域的认识和关注，从而使这个词可以在其他专业和同事中传播。阿片类药物在慢性疼痛综合征的治疗中没有作用。