[...]... and individualized treatment planning Using algorithms for treatment Fear of criticism; increasing bureaucratic regulation of medical care with guidelines becoming ‘recipes’ Identification of themselves as a ‘patient’ and increasing the sick role Comprehensive assessment of the type of pain quality, location, mitigating and exacerbating features Pain as a vital sign and linear assessment of pain severity... After all, upon cursory examination, there seem few pharmacological similarities among addictive drugs Some – including barbiturates, ethanol, opiates and benzodiazepines – are sedatives, while others – including nicotine, cocaine and the amphetamines – are stimulants Some – including opiates and cannabinoids – are antinociceptive, while others (in the proper laboratory or clinical situations) are pronociceptive... depressing wall-mounted levers in their test chambers) in order to receive such brain stimulation In the aftermath of this discovery of the phenomenon of brain stimulation reward, Olds and Olds [7–10] carried out extensive mapping studies of the rodent brain, confirming that a large majority of the brain sites supporting brain stimulation reward are associated with the nuclei of origin, tracts and terminal... circuits including cholinergic, endorphinergic, serotonergic, GABAergic, glutamatergic, enkephalinergic, dynorphinergic and substance P-containing neural elements [1] Addictive drugs of different classes act on this three-neuron, in- series brain reward neural circuit at different points to activate the circuit and produce the drug-induced 24 Gardner high Barbiturates, benzodiazepines, cannabinoids,... disability and impede their recovery Behavioral conditioning contributes to chronic pain disorders in the form of both classical (Pavlov) and operant (Skinner) conditioning that increases the experience of pain, the liability to ongoing injury, the central amplification of pain, the use of reinforcing medications such as opiates and benzodiazepines, and behaviors associated with disability The term... will overcome even intensely aversive experiences is amply demonstrated by the resilience of behaviors involving eating, sleeping, drinking and sexual activity The central issue for drug users is that unlike feeding, sleeping and sexual behaviors, addictive compounds were not present in the environment during the millions of years that this cycle took to evolve, and therefore the intrinsic ‘turn-off ’... responsive to reinforcement, some being more consequence avoidant and others more reward seeking Each patient needs ongoing monitoring of results and ongoing adjustment of the treatment plan In table 4, we have included some interventions we find useful We discuss these with the patient and tend to be very transparent about our behavioral techniques Patients may play an active role in selecting reinforcers... paradigm [4] B.F Skinner described operant conditioning as the shaping of behavior using positive or negative responses to the behavior [5] He described four types of operant reinforcement, as shown in table 1: positive reinforcement, where a behavior results in the delivery of something that is rewarding; negative reinforcement, where the behavior results in the removal of something unpleasant; punishment,... reinforcement (behavior increases) punishment (behavior decreases) withdraw Stimulus when behavior occurs negative extinction (behavior decreases) negative reinforcement (behavior increases) Four cells of operant conditioning: positive reinforcement, where a behavior results in the delivery of something that is rewarding (increases the behavior); negative reinforcement, where the behavior results in. .. of something unpleasant (increases the behavior); punishment, where the behavior results in the delivery of something unpleasant (decreases the behavior), and extinction, where the behavior results in the removal or lack of delivery of something rewarding (decreases the behavior) effects in humans, and therefore behaviors associated with the administration of opiates increase in frequency and intensity . Cataloging -in- Publication Data Chronic pain and addiction / volume editors, M.R. Clark, G.J. Treisman. p. ; cm. (Advances in psychosomatic medicine, ISSN.