Newswise — Though opioid pain medications are effective for treating chronic pain, many physicians are reluctant to prescribe them fearing potential for addiction and abuse. Harvard researchers may have an answer to this problem with a new screening tool, published in The Journal of Pain, to predict which pain patients are most likely to exhibit aberrant medication-related behavior.
The estimated prevalence of addiction to any substance in pain patients is about 10 percent, yet most physicians who prescribe potent pain drugs have little training in addiction or confronting aberrant drug behavior. Even though substance abuse is evident in chronic pain patients, potential addiction risk does not outweigh the benefit of effective pain management. Optimal use of opioids, therefore, requires physicians to evaluate potential drug-abuse risks in their patients. But how?
Researchers at the Pain Management Center at Harvard's Brigham and Women's Hospital sought to improve deficiencies in screening questionnaires used to identify which chronic pain patients could be at risk for abusing their pain medication. The purpose of the study was to develop and validate a new, revised version of the standard questionnaire (Screener and Opioid Assessment for Patients with Pain), but with enhancements to include patient self reports with provider observations and toxicology results.
Fifty-five chronic pain patients were randomly selected to complete the new screening survey from a group of 283 that had completed the standard questionnaire. The researchers determined the revised survey elicited information critical for determining which chronic pain patients may have problems with long-term opioid therapy. From an initial pool of 142 items, the final questionnaire was reduced to 24. They probed for problems with mood, temperament, feelings of impatience and frustration. Several items were related to attitudes about pain medication.
The authors concluded the revised screening tool is an improvement on the original questionnaire in identifying drug abuse risk potential among chronic pain patients. It was found to be more reliable and less susceptible to deception.
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