Redefining Pain and Addiction: How Opioid Manufacturers Changed Medical Language to Foster Opioid Use.

The role of pharmaceutical companies in promoting overuse of opioids by influencing medical discourse is underexamined. Marketing messages have been seeded in journal articles, continuing medical education (CME), prescribing guidelines, educational activities, and professional society recommendations. Terms generated or redefined by industry created a framework for promoting opioids. This paper focuses on the terms "opiophobia," "pseudoaddiction," "breakthrough pain" and "pain is the 5th vital sign." The reframing of incipient opioid use disorder as "tolerance" and "dependence" is also discussed. The proliferation of these industry-supported terms within medical discourse created a false evidence base that opioids were safe and effective for chronic pain and that withholding opioids deprived patients of the best care.