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To the Editor:—Dr. Berg and colleagues provide interesting insights into the dilemma of treating pain among patients with co-morbid addiction.1 They found a dichotomy and tension between a decision-making framework that focused on abuse (framework 1) and another that focused on treating pain (framework 2), and report that most providers adhered to one or the other. I have also observed this dichotomy, but I suspect that the decision-making framework of providers is not always static. Over time, I find myself moving from framework 2 (focused on treating pain) toward framework 1 (concerned about abuse). I realize that the number of providers in this study was fairly small, but I wonder if the authors found a similar trend among their providers, i.e., were the providers who were more concerned about abuse (framework 1) older or more experienced than the others?