This section has two purposes: First, to provide a series of scientific papers on the various aspects of toxicity exhibited by many drugs used in the therapy of CRPS/RSD/chronic pain. Second, to clarify the ever-present confusion about these terms and how they apply to certain drug situations, especially involving medications used for CRPS.
Addiction - Used interchangeably with dependence, addiction is defined as "when an individual persists in use of alcohol or other drugs, or engaging in certain behaviors, despite problems related to use of the substance, substance dependence may be diagnosed." Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders." Addiction is a primary illness, which follows a predictable course and responds to treatment similarly across many patient populations.
It should be stressed that the non-substance addictions and compulsions are just as serious as substance-based addictions, and can be just as fatal. These include gambling, sex, eating, codependency, and many more. The best definition of addiction I've heard is this: "Addiction is the condition of compulsively repeating any behavior that causes us shame."
Dependence - see Addiction.
Tolerance - A physiological adaptation to the use of certain drugs over an extended period of time, resulting in a need for markedly increased amounts of the substance to achieve intoxication or desired effect, and/or a markedly diminished effect with continued use of the same amount of the substance. Unrelated to dependence or addiction.
Withdrawal - the group of symptoms that occur upon the abrupt discontinuation or decrease in intake of medications or recreational drugs for which tolerance has set in. It is thus a physiological phenomenon, and will thus be experienced by most long-term users of any drug that produces tolerance. Thus, like tolerance, it is unrelated to addiction.
The severity, perception of severity, and duration of withdrawal symptoms depend heavily on the specific drug(s), time span of drug use prior to discontinuation, dose at discontinuation, the personality of the user, whether addiction has set in, and other factors.
In this compilation of papers, I decided to forgo my usual practice of commenting, essentially describing what the article is all about. These titles are so uncharacteristically clear that I decided to leave out the comments. If you have an opinion as to whether you prefer the comments be included in any case, please let me know.
Everyone knows that benzodiazepines ("benzos") can be addictive (they're C-IV), but little hard data are available to the benzo-taking public, and the entire world consumes benzos at a rate that's just incredible. As with so many other drugs, the pharmas that develop and market the drugs want to accentuate their positive aspects and play down, if not ignore completely, their drawbacks.
What moved me to include this section* is that benzo withdrawal can be more than feeling just horrible for days; there are at least two benzos, withdrawal from which has resulted in fatalities, which is NOT common for drug withdrawals. Xanax is the worst of these and, ironically, is the most prescribed benzo on the market. And lots and lots of CRPS patients take Xanax in large quantities.
* These data were acquired from an article from the very good psychcentral.com site; the specific article can be accessed here. It covers many other psychoactive drugs other than the benzos highlighted here.
There is a single BZ antagonist approved by the FDA, called flumazenil, but it has not found use yet in BZ detoxification or addiction treatment.