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Patient Assessment Tools

Patient Assessment Tools

Numerous tools have been proposed to facilitate the assessment of patients being considered for or receiving opioid therapy for chronic pain. These tools vary in their complexity and the degree to which they have been validated.1,2 The tools listed below may help you carry out some of the suggested 4 steps for universal precautions with opioid therapy for patients with chronic pain. Note that this is not an exhaustive list of all tools that could potentially be used for this purpose.

Brief Pain Inventory (BPI)

The BPI is a well-established tool for assessing a patient’s level of analgesia (pain control) and activity (function)—2 of the “4 A’s” —at baseline and throughout opioid therapy.3,4

Opioid Risk Tool (ORT)

The ORT consists of 5 items that may help you assess a patient’s risk for aberrant behavior (see Glossary) before prescribing an opioid.5

Patient Health Questionnaire 4 (PHQ-4)

A history of psychological illness has been positively associated with the risk for aberrant behavior (see Glossary) related to prescription opioids.5 The 4-item PHQ-4 is designed to detect the presence of depression and anxiety and thus may help with the psychological assessment.6,7

Follow-up Screening Instruments (Patient Questionnaires)

A number of patient questionnaires have been developed to help identify aberrant drug-related behaviors in those receiving prescription opioid therapy.8 See Assessing for Potential Aberrant Behavior for more information.


  1. Washington State Agency Medical Directors’ Group (AMDG). Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An Educational Aid to Improve Care and Safety With Opioid Therapy. 2010 Update. Olympia, WA: Washington State Agency Medical Directors Group; 2010. Accessed May 20, 2014.
  2. Sehgal N, Manchikanti L, Smith HS. Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse [review]. Pain Physician. 2012;15(3 suppl):ES67-ES92. PMID: 22786463
  3. Cleeland CS. The Brief Pain Inventory: User Guide. 2009. Accessed May 20, 2014.
  4. Breivik H, Borchgrevink PC, Allen SM, et al. Assessment of pain. Br J Anaesth. 2008;101(1):17-24. PMID: 18487245
  5. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6(6):432-442. PMID: 16336480
  6. Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics. 2009;50(6):613-621. PMID: 19996233
  7. Löwe B, Wahl I, Rose M, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire 4 (PHQ-4) in the general population. J Affect Disord. 2010;122(1-2):86-95. PMID: 19616305
  8. Chou R, Fanciullo GJ, Fine PG, Miaskowski C, Passik SD, Portenoy RK. Opioids for chronic noncancer pain: prediction and identification of aberrant drug-related behaviors: a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009;10(2):131-146. PMID: 19187890