­Quick Screening Method May Help Predict Opioid Abuse

Two teams of researchers are working toward preventing long-term opioid use and misuse among patients with pain, according to 2 studies presented at the American Pain Society’s 35th Annual Scientific Meeting.

In an effort to prevent opioid misuse and allow primary care providers to simplify the identification of individuals at risk for opioid abuse, the first group of researchers¹ developed the single-question Catastrophizing Subscale from the Single Item Form of the Coping Strategies Questionnaire (CSQ3)—a quick and easy screening method that prompts patients to rate agreement with the following statement about their pain: “It is terrible and I feel it is never going to get better.”
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Previous research has shown that this score is a strong predictor of pain catastrophizing, a risk factor for opioid abuse.

For their study, the researchers examined data from 119 patients referred for screening for possible long-term opioid therapy. The predictive ability of the CSQ3 was compared with the 13-item Pain Catastrophizing Scale (PCS), the current standard for measuring risk of catastrophizing, in predicting risk for abuse on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), which is used in the clinical setting for predicting opioid misuse.

After analyzing the data, the researchers found that the CSQ3 had a large predictive ability; however, the PCS was a stronger indicator of high scores on the SOAPP-R than the CSQ3 was, they noted.

“Thus, CSQ3 does a good job of predicating SOAPP-R but is not as effective as PCS,” they concluded.

“These findings suggest a single question assessing for Catastrophizing has both clinical utility as an easily administered, scored and interpreted screener and, empirical validity in health-based settings as an initial screen for elevated risk for opioid misuse in chronic pain samples."

In the second study,² the researchers performed a retrospective chart review of 416 patients who completed questionnaires in the Stanford Collaborative Health Outcomes Information Registry (CHOIR) to examine prescription opioid use 6 months after the initial visit.

The analysis showed that 51% of patients were taking opioids 6 months after their initial visit.

The strongest factors associated with continued opioid use at 5 months included the use of an opioid at initial clinic visit and aberrant drug-related behaviors. Those with aberrant drug behaviors were 14.95 times more likely to continue opioid use at 6 months than those without. Those with self-reported physical functioning were more likely to have lower rates of opioid use at 6 months, with every 10-point increase in physical functioning at the initial visit decreasing the odds of opioid use at 6 months.

“Given the myriad risks associated with long-term prescription opioid therapy, it is essential for providers to identify patients at risk for prolonged opioid use,” the researchers concluded. “As a first step, our research identifies significant patient characteristics that may predict prolonged opioid use and associated complications.”

—Amanda Balbi

References:

1. Gross R, Long D, Cox S. Predicting opioid misuse with a brief screener of catastrophizing. Paper presented at: American Pain Society 35th Annual Scientific Meeting; May 11-14, 2016; Austin, TX. http://www.jpain.org/article/S1526-5900(16)00130-9/abstract. Accessed June 2, 2016.
2. Hah J, Sharifzadeh Y, Mackey S. Risk factors for long-term prescription opioid therapy for chronic non-cancer pain. Paper presented at: American Pain Society 35th Annual Scientific Meeting; May 11-14, 2016; Austin, TX. http://www.jpain.org/article/S1526-5900(16)00072-9/abstract. Accessed June 2, 2016.