What is the medical term for creating an illness to receive prescriptions for pain medicine?

Medical Terminology for Creating Illness to Obtain Pain Medications

The medical term for creating an illness in order to receive prescriptions for pain medicine is "factitious disorder," with more severe cases known as "Munchausen syndrome." 1, 2

Distinguishing Between Related Conditions

When evaluating patients who appear to be creating illness for pain medications, it's important to understand the differences between several related conditions:

1. Factitious Disorder:

   • Characterized by falsification of medical symptoms in the absence of obvious external rewards
   • The primary motivation is to assume the sick role
   • Patients deliberately create or exaggerate symptoms 2, 3

2. Malingering:

   • Intentional fabrication of symptoms for external gain (e.g., obtaining medications, financial compensation)
   • Unlike factitious disorder, there is a clear external incentive 4, 5
   • Often seen in contexts where pain-contingent compensation is available

3. Pseudoaddiction:

   • Behavioral changes that mimic addiction but are actually due to inadequate pain control
   • Patients seek medication because of unrelieved pain, not for euphoric effects 6
   • Resolves when pain is adequately treated

4. Drug-seeking behavior:

   • Directed efforts to obtain opioid medication
   • May be appropriate in cases of undertreated pain or may indicate addiction 6
   • Can include "doctor shopping," emergency visits near closing time, or reported "lost" prescriptions

Clinical Presentation and Warning Signs

Key indicators that may suggest factitious disorder or malingering related to pain medications:

• Inconsistent or vague symptom descriptions that don't match objective findings
• Extensive medical history with multiple hospitalizations at different facilities
• Reluctance to provide prior medical records
• Knowledge of medical terminology beyond expected level
• Symptoms that worsen when being observed
• Resistance to diagnostic procedures that might confirm or rule out claimed condition
• "Doctor shopping" behavior 7
• Emergency calls or visits near the end of office hours 7
• Repeated "loss" of prescriptions 7

Management Approach

When factitious disorder is suspected in a patient seeking pain medications:

1. Maintain professional objectivity:

   • Avoid accusatory language or confrontation
   • Document observations carefully and objectively

2. Conduct thorough assessment:

   • Look for objective evidence of pain
   • Verify medical history with previous providers when possible
   • Distinguish between true drug-seeking and pseudoaddiction 8

3. Implement appropriate pain management:

   • Consider non-opioid analgesics as baseline therapy (NSAIDs, acetaminophen) 8
   • Use multimodal analgesia to decrease total opioid requirements 8
   • Consider adjuvant medications like antiepileptics or antidepressants for appropriate pain syndromes 8

4. Set clear boundaries:

   • Establish a controlled substance agreement
   • Schedule regular follow-ups rather than as-needed visits
   • Implement urine drug screening when appropriate
   • Document all interactions carefully

5. Consider psychiatric referral:

   • A multidisciplinary approach involving psychiatry can help address underlying issues 2, 3
   • Early psychiatric involvement may prevent escalation of factitious behaviors

Important Caveats

• Misdiagnosis of factitious disorder can lead to undertreated pain and suffering
• Patients with a history of substance use disorders may have legitimate pain needs
• The FDA warns that "preoccupation with achieving adequate pain relief can be appropriate behavior in a patient with inadequate pain control" 7
• Avoid stigmatization of patients with pain and substance use history 8
• Factitious disorder can lead to serious medical complications and even death if not properly identified and managed 2

Remember that the diagnosis of factitious disorder is often challenging and requires careful documentation of objective findings and behaviors rather than assumptions about patient motivation.