Physical dependence is usually clinically unimportant as long as abstinence is avoided, and, in fact, the major problem with this phenomenon is its mislabeling by clinicians. The term addiction should never be applied solely to the perceived capacity for abstinence. This serious error stigmatizes the patient and the therapy. The capacity for withdrawal should always be labeled physical dependence. Pain specialists and addictionists alike must work to clarify this nomenclature.
Tolerance is the diminution of drug effect over time as a consequence of exposure to the drug.
For many in the addiction community, tolerance is viewed as a major problem that drives addiction by producing a need for progressively higher doses to achieve desired psychic effects. Many clinicians, including some who specialize in pain management, also assume that tolerance is a common problem during long-term opioid therapy for painful disorders and that it precludes successful treatment for many patients. To clarify the nature of the phenomenon, pain specialists and addictionists must begin to describe tolerance as a complex process that may or may not be clinically desirable. During opioid therapy for pain, tolerance to side effects is beneficial and is presumably the reason that patients can function normally. Tolerance to analgesia would be a problem, but fortunately this process seldom appears to be the driving force for dose escalation.