Opioid Assessment Research Articles

Opioid analgesia and assessment of the sonographic Murphy sign

Administration of intravenous opioid analgesia to patients with undifferentiated abdominal pain remains a controversial topic in many emergency departments. To determine whether opioid analgesia impacts assessment of the sonographic Murphy sign (SM) in evaluating acute gallbladder disease (GBD), a retrospective chart review was undertaken. The chart review encompassed 119 patients, 21% of whom, having received opioid analgesia before ultrasound, constituted the opioid group. Between the opioid and control (i.e., no opioid analgesia) groups, there were no significant differences in SM sensitivity (48.2%; CI 28.7–68.1% vs. 68.8%; CI 41.3–89%, respectively) or specificity (92.5%; CI 83.4–97.5% vs. 88.9%; CI 51.8–99.7%, respectively) for GBD. There was no association between opioid analgesia and false-positive SM (OR 0.74, CI 0.08–6.65), or false-negative SM (OR 1.42, CI 0.46–4.43). We conclude that the test characteristics of SM are unaffected by opioid analgesia.

Validation and comparison of the SOAPP (Screener and Opioid Assessment for Patients with Pain) in two pain centers

Validation and comparison of the SOAPP (Screener and Opioid Assessment for Patients with Pain) in two pain centers

Validation of a screener and opioid assessment measure for patients with chronic pain

There has been a need for a brief assessment tool for providers who treat chronic pain patients to determine potential risk of abuse when prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a self-administered screening tool (Screener and Opioid Assessment for Patients with Pain, SOAPP) for chronic pain patients considered for long-term opioid therapy. A consensus of 26 pain and addiction experts was obtained on important characteristics of chronic pain patients that predict future medication misuse using concept mapping. A 24-item SOAPP (version 1.0) was developed based on this consensus and was administered to 175 patients who were taking opioids for chronic pain. After 6 months, 95 of these patients were re-evaluated. Validation of the SOAPP was conducted by identifying those patients exhibiting aberrant drug-related behavior as determined by any of the following: a positive score on the Prescription Drug Use Questionnaire (PDUQ) interview, positive urine toxicology screen, and/or ratings by staff as to whether patients had a serious drug problem. Of the original 24 items, 14 SOAPP items appeared to predict subsequent aberrant behaviors. Coefficient α for these 14 items was acceptable for a short scale (0.74). Receiver operating characteristics curve analysis yielded an area under the curve of 0.881 ( P<0.001), suggesting adequate sensitivity and specificity for a screening device. These reliability and predictive validity results suggest that the SOAPP is a promising step toward screening risk potential for substance misuse among persons with chronic pain.

Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients

The purposes of this prospective repeated measures study were to: (a) describe the occurrence of withdrawal symptoms with the use of a standardised protocol to slowly taper opioids and benzodiazepines; and (b) to test the predictive validity of an opioid and benzodiazepine withdrawal assessment scoring tool in critically ill infants and young children after prolonged opioid and benzodiazepine therapy. Fifteen children (6 weeks-28 months of age) with complex congenital heart disease and/or respiratory failure who received opioids and benzodiazepines for 4 days or greater were evaluated for withdrawal symptoms using a standardized assessment tool. Thirteen children showed moderate to severe withdrawal symptoms a median 3 days after commencement of tapering. Symptom intensity was not related to prior opioid or benzodiazepine exposure, extracorporeal membrane oxygenation (ECMO) therapy or length of tapering. Children who received fentanyl in addition to morphine more often exhibited signs of withdrawal. This study demonstrated that significant withdrawal symptoms occur in critically ill children even with the use of a standardised assessment tool and tapering management protocol. The predictive validity and utility of the Opioid and Benzodiazepine Withdrawal Score (OBWS) was adequate for clinical use, but areas for further improvement of the tool were identified. Problems with the clinical withdrawal prevention and management guidelines were also identified. More research is needed to establish the optimal methods for prevention and management of iatrogenic opioid and benzodiazepine withdrawal in paediatric critical care.

Clinical outcomes measurement: Validation of screener and opioid assessment for patients with pain

There has been a need for a brief assessment tool for providers treating chronic pain patients to determine potential risk of abuse when prescribed opioids for pain. The purpose of this study was to develop and begin the validation of a self-administered, brief screening tool (Screener and Opioid Assessment for Patients with Pain; SOAPP) for chronic pain patients considered for long-term opioid therapy. A consensus of 26 pain and addiction experts was obtained on important characteristics of chronic pain patients that predict future medication misuse using concept mapping. Eight conceptual clusters were defined: (1) psychosocial problems, (2) psychiatric history, (3) substance abuse history, (4) antisocial behaviors/history, (5) doctor-patient relationship factors, (6) medication-related behaviors, (7) emotional attachment to pain medication, and (8) personal care and lifestyle issues. A 24-item SOAPP (version 1.0) was developed based on this consensus and was administered to 154 patients who were taking opioids for chronic pain. After six months, one hundred of these patients were re-administered the SOAPP and interviewed using the Prescription Drug Use Questionnaire (PDUQ). Patients below the lower cutoff on the PDUQ do not show medication misuse problems, while those above the higher cutoff are likely to have such problems. Of the original 24 items, 16 items appeared to predict subsequent PDUQ scores. Coefficient á for these 16 items was acceptable for a short scale (.73). Preliminary receiver operating characteristics (ROC) curve analyses yielded an area under the curve (AUC) for the lower cutoff of .92 (p<0.001), while the AUC for the higher cutoff was .84 (p<0.05). Further refinement and testing of the scale are planned. These reliability and predictive validity figures suggest that the SOAPP is a promising step toward determining risk potential for substance misuse among persons with chronic pain.