Screener And Opioid Assessment For Patients With Pain-Revised Research Articles

(185) Reducing the respondent burden of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): an approach using curtailment and stochastic curtailment

(185) Reducing the respondent burden of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): an approach using curtailment and stochastic curtailment

Validation of a new risk assessment tool: the Brief Risk Questionnaire.

Opioids remain a common method of treating chronic pain conditions despite some controversy. In an effort to address some of the risks of opioid medications, opioid risk assessment has become a standard of care when opioids are used to treat a chronic pain condition. Research to date has found that many currently available patient-completed written questionnaires are relatively poor at identifying which patients will engage in medication aberrant behavior in the future. Clinical interview techniques have been found to provide better prediction, but practitioners often prefer the convenience of patient-completed tools. In this study, a new brief patient-completed risk tool, the Brief Risk Questionnaire (BRQ), was created and compared with a structured clinical interview and two commonly used patient-completed risk assessment tools: the Opioid Risk Tool (ORT) and Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). The different risk assessment measures were administered to 454 patients at a pain clinic and their prediction of medication aberrant behavior at 6-month follow-up was compared. Results found that the BRQ was able to predict future medication aberrant behavior better than the other two patient-completed risk measures and almost as well overall as a structured clinical interview rating system. This study indicates that the BRQ could be a useful new tool for clinicians in conducting opioid risk assessment.

Further validation of an opioid risk assessment tool: the Brief Risk Interview.

Opioids remain a common method of treating chronic pain conditions despite some controversy. In an effort to address some of the risks of opioid medications, opioid risk assessment has become a standard of care when opioids are used to treat a chronic pain condition. Research to date has found that clinical interviews may be superior to currently available patient-completed written questionnaires in identifying patients likely to engage in medication aberrant behavior. The Brief Risk Interview (BRI) has been developed as a risk assessment tool that has the sensitivity of a clinical interview while eliminating the need for the lengthy process of an interview. The current study compared the predictive ability of the BRI with two commonly used patient-completed risk assessment tools: the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). After clinical staff at a pain practice underwent a 1-hour training program, 124 consecutive new patients were evaluated using the BRI, ORT, and SOAPP-R. Follow-up data found that the BRI was a good predictor of medication aberrant behavior and offered better sensitivity and better overall predictive accuracy than the ORT or the SOAPP-R. Overall, it appears that the BRI is a valid risk assessment tool that, after a brief training session, can be used effectively by pain clinicians. Further study is needed in other practice settings and with larger sample sizes.

Aberrant Drug-Related Behavior Observed During a 12-Week Open-Label Extension Period of a Study Involving Patients Taking Chronic Opioid Therapy for Persistent Pain and Fentanyl Buccal Tablet or Traditional Short-Acting Opioid for Breakthrough Pain

Evaluate aberrant drug-related behaviors in patients administering fentanyl buccal tablet or traditional short-acting opioids for breakthrough pain. Twelve-week open-label extension. Forty-two US sites. Opioid-tolerant patients with chronic pain who completed the previous randomized, double-blind, crossover portion of a study comparing fentanyl buccal tablet and immediate-release oxycodone for treatment of breakthrough pain. Patients were rerandomized to continue treatment with fentanyl buccal tablet or begin any traditional short-acting opioid. Assessments included Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) at baseline and Addiction Behaviors Checklist and Current Opioid Misuse Measure at baseline and final visit. Case report forms were reviewed retrospectively to identify aberrant drug-related behaviors. One hundred thirty patients entered the open-label extension (fentanyl buccal tablet, N = 65; traditional short-acting opioid, N = 65). SOAPP-R scores were <18 (low risk of aberrant drug-related behavior) in 74% of patients; no significant differences in SOAPP-R scores were observed between treatment groups. At the final visit, ≤14% of patients in each treatment group had scores indicating potential aberrant drug-related behavior (Addiction Behaviors Checklist ≥3, Current Opioid Misuse Measure ≥9); no significant differences in scores were observed between treatment groups. Baseline SOAPP-R score ≥18 was not predictive of Addiction Behaviors Checklist ≥3 but was predictive of Current Opioid Misuse Measure ≥9. Aberrant behaviors were identified in 12 (18%) fentanyl buccal tablet patients and 13 (20%) traditional short-acting opioid patients. Incidence of aberrant drug-related behaviors was similar between patients taking fentanyl buccal tablet and traditional short-acting opioids over 12 weeks.

What question set is most effective to screen chronic pain patients for potential opioid abuse?

Evidence-Based Answer The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) appears to better predict potential opioid abuse than the Opioid Risk Tool (ORT), Pain Medication Questionnaire (PMQ), or Diagnosis Intractability Risk and Efficacy inventory (DIRE) score (SOR: B, multiple cohort studies).

Spanish Translation and Linguistic Validation of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)

Dear Editor, We commend Butler et al. for their Spanish translation of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) [1]. This linguistic translation is an important first step in widening the clinical reach of a tool that makes opioid prescribing safer. As the authors of this newly translated tool clearly recognize, Hispanics/Latinos are the largest minority group in the United States. The high prevalence of illiteracy and low literacy among Hispanic groups represent a barrier to the appropriate understanding of chronic pain, its management, and the specific risk of opioid analgesics. Often, non-English-speaking patients and those with limited education are specifically excluded from clinical research. As a consequence, the risks of these therapies are …

Assessment of Narcotics Use and Smoking in Chronic Pancreatitis Patients

Purpose: Chronic Pancreatitis (CP) poses a significant worldwide problem, but remains difficult to treat. CP pain can impact a number of quality of life issues. Numerous studies have demonstrated an increased risk of pancreatitis linked to smoking, independent of alcohol use. No previous studies have been done to assess the impact of smoking on narcotics use in CP patients. The primary endpoint was the evaluation of narcotic use on CP patients. The secondary endpoints included the impact of smoking on narcotic use and other aspects of health in CP patients. Methods: Patients in our CP clinic (previously diagnosed by EUS) currently on narcotic medications were given a series of 10 previously validated questionnaires These questionnaires specifically addressed quality of life, alcohol and drug use, coping mechanisms, opioid addiction, anxiety and depression, nutrition, pain, and smoking (Table 2).Table 2: Screening instrument resultsResults: In total, 15/15 patients responded to the surveys. Patient characteristics are described in Table 1. All 15 patients scored high enough on the Michigan Alcohol Screening Test (MAST), the Drug Alcohol Screening Test (DAST), and the Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R) to be categorized as alcoholics, having a drug abuse problem, and having an opioid addiction, respectively (p < 0.0002). On the Short Form-12, all 15 patients scored below average on the physical component (p < 0.0002), and 13/15 scored below average on the mental component (p < 0.005). Table 2. 9/15 patients currently smoke, and 9/9 (p <0.003) expressed an interest in quitting. Patients who smoke also scored significantly higher in opioid addiction scores (p <0.02) compared to those who did not (Table 2).Table 1: DemographicsConclusion: Our evaluation demonstrated revealing trends in terms of alcohol abuse, opioid addiction, and general health in patients with CP. These results suggested a correlation with smoking and opioid addiction and also revealed an alarming rate of unemployment in these patients. In line with this, there appears to be potential for smoking cessation intervention in improving quality of life.

Spanish Translation and Linguistic Validation of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)

Given the increase in misuse and abuse of prescription opioids, clinicians clearly benefit from a standardized tool to screen patients being considered for chronic opioid therapy. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a widely used opioid risk assessment tool in clinical practice. As one third of the US population experiences chronic noncancer pain at any given time, and the Hispanic population now accounts for about 16% of the nation's population, the availability of a Spanish-language SOAPP-R fills an important clinical need. To derive a linguistically validated Spanish-language version of the SOAPP®-R. Each step of Spanish translation and linguistic validation of the SOAPP-R was based on the US Food and Drug Administration and the International Society for Pharmacoeconomics and Outcomes Research translation process. A linguistically validated Spanish-language version of the SOAPP-R. The Spanish SOAPP-R may be useful as a risk assessment tool, considered along with other clinical information, by clinicians who prescribe opioid therapy for patients whose preferred language is Spanish.

A Comparison of Various Risk Screening Methods in Predicting Discharge From Opioid Treatment

Risk assessment and stratification has become an important aspect of the prescribing of opioids to patients with chronic pain. There is little empirical data available on the sensitivity and specificity of commonly used risk assessment tools. This paper describes 2 studies that compare the prediction capabilities of various risk assessment tools. The first study presents data on patients at a pain practice whose treatment with opioids was stopped due to their engaging in aberrant drug-related behavior. Patients were assessed with the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), the Pain Medication Questionnaire, the Opioid Risk Tool, and a clinical interview. A second study compared the risk assessment measures, SOAPP-R, Pain Medication Questionnaire, Opioid Risk Tool, and a clinical interview. Data were gathered on whether patients had engaged in aberrant drug-related behavior at 6-month follow-up. Significant differences in the measures were found. Accuracy did not appear to be a function of the type of aberrant drug-related behavior that the patient engaged in for any of the measures. The clinical interview showed the best sensitivity of the 4 risk measures in predicting risk. The SOAPP-R showed the best sensitivity of the self-report measures. However, the SOAPP-R appears to overrate risk. Overall, these studies indicate that not all risk assessment tools are equal in their ability to accurately predict future aberrant drug-related behavior. It may be that written risk assessment tools that use more subtle items are better suited to certain patient populations.

Elevated Pain Sensitivity in Chronic Pain Patients at Risk for Opioid Misuse

This study employed quantitative sensory testing (QST) to evaluate pain responses in chronic spinal pain patients at low risk and high risk for opioid misuse, with risk classification based on scores on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). Patients were further subgrouped according to current use of prescription opioids. Of the 276 chronic pain patients tested, approximately 65% were taking opioids; a median split was used to further categorize these patients as being on lower or higher doses of opioids. The high-risk group (n = 161) reported higher levels of clinical pain, had lower pressure and thermal pain thresholds at multiple body sites, had lower heat pain tolerance, and rated repetitive mechanical stimuli as more painful relative to the low-risk group (n = 115; P’s < .01). In contrast, QST measures did not differ across opioid groups. Multiple linear regression analysis suggested that indices of pain-related distress (ie, anxiety and catastrophizing about pain) were also predictive of hyperalgesia, particularly in patients taking opioids. Collectively, regardless of opioid status, the high-risk group was hyperalgesic relative to the low-risk group; future opioid treatment studies may benefit from the classification of opioid risk, and the examination of pain sensitivity and other factors that differentiate high- and low-risk groups. Perspective This study demonstrates that chronic spinal pain patients at high risk for misuse of prescription opioids are more pain-sensitive than low-risk patients, whether or not they are currently taking opioids. Indices of pain-related distress were important predictors of pain sensitivity, particularly among those patients taking opioids for pain.

Cross-Validation of a Screener to Predict Opioid Misuse in Chronic Pain Patients (SOAPP-R)

The Screener and Opioid Assessment for Patients with Pain - Revised (SOAPP-R) is a self-report questionnaire designed to predict aberrant medication-related behaviors among persons with chronic pain. This measure was developed to complement current risk assessment practices and to improve a clinician's ability to assess a patient's risk for opioid misuse. The aim of this study was to cross-validate the SOAPP-R with a new sample of chronic, non-cancer pain patients. Three hundred and two participants (N=302) prescribed opioids for pain were recruited from five pain management centers in the U.S. Subjects completed a series of self-report measures and were followed for five months. Patients were rated by their treating physician, had a urine toxicology screen, and were classified on the Aberrant Drug Behavior index. Seventy-three percent (73.2%) of the subjects (N= 221) were followed and 66 participants repeated the SOAPP-R after one week for test-retest reliability. The reliability and predictive validity, as measured by the area under the curve (AUC), were found to be highly significant (test-retest reliability = .91; coefficient alpha = .86; AUC = .74) and were sufficiently similar to values found with the initial sample. A cut-off score of 18 revealed a sensitivity of .80 and specificity of .52. Results of this cross-validation study suggest that the psychometric parameters of the SOAPP-R are not based solely on the unique characteristics of the initial validation sample. The SOAPP-R is found to be a reliable and valid screening tool for risk of aberrant drug-related behavior among chronic pain patients.