Abstract
Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician's clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach's α = 0.77) and test-retest reliability (r = 0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P < 0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician's evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use.
Highlights
The problem of poorly controlled pain is still considerable: in Europe 19% of adults suffer from continuous pain that seriously compromises the quality of their emotional, social, and working life [1]
Such different rates may be due to a lack of a universally accepted definition of terms that describe the various types of incorrect behavior consequent to chronic opioid prescription
As regards the psychological variables investigated in the pretreatment assessment we found that, based on the personality profile obtained with MMPI-2, 24.5% of women and 27.7% of men had clinically significant scores (T scores ≥ 65) in at least one of the clinical scales with psychopathological content (Paranoia, Schizophrenia, and Hypomania)
Summary
The problem of poorly controlled pain is still considerable: in Europe 19% of adults suffer from continuous pain that seriously compromises the quality of their emotional, social, and working life [1]. Some patients benefit from such treatment in terms of pain reduction and improvement in quality of life, while others do not [3]. Absence of any improvement in physical function, misuse, abuse, and addiction are relatively common during chronic opioid administration. The American literature reports overall rates of opioid misuse and abuse ranging from 4% to 26% [4, 5]. Such different rates may be due to a lack of a universally accepted definition of terms that describe the various types of incorrect behavior consequent to chronic opioid prescription. It is obvious that a clear and accepted terminology is necessary for improving communication and statistics
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