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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

Screener and Opioid Assessment for Patients with Pain – Revised (SOAPP-R)

The SOAPP-R is a questionnaire that helps assess and predict a patient’s risk for opioid abuse.6,7

Patient Health Questionnaire 2 (PHQ-2)

A history of psychological illness has been positively associated with the risk for aberrant behavior (see Glossary) related to prescription opioids.5 The 2-item PHQ-2 is designed to detect the presence of depression and anhedonia and thus may help with the psychological assessment.8,9

Diagnosis, Intractability, Risk, and Efficacy

The D.I.R.E. Score is a validated tool to predict the efficacy of analgesia and patient compliance with long-term opioid therapy. It consists of 4 factors that are individually scored and totaled to obtain the D.I.R.E. Score.10

ID PAIN Screener

The ID Pain Screener is a short (6-item) questionnaire to help screen for neuropathic pain.11

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.12 One of these questionnaires is the Current Opioid Misuse Measure (COMM).13,14 See Assessing for Potential Aberrant Behavior for more information.

References

  1. Washington State Agency Medical Directors’ Group (AMDG). Interagency Guideline on Opioid Dosing for Chronic Noncancer Pain: An Educational Aid to Improve Care and Safety With Opioid Therapy. 2010 Update. Olympia, WA: Washington State Agency Medical Directors Group; 2010. http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf. Accessed November 6, 2017.
  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. http://www.mdanderson.org/education-and-research/departments-programs-and-labs/departments-and-divisions/symptom-research/symptom-assessment-tools/BPI_UserGuide.pdf. Accessed November 6, 2017.
  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. Butler SF, Budman SH, Fernandez KC, Fanciullo GJ, Jamison RN. Cross-Validation of a Screener to Predict Opioid Misuse in Chronic Pain Patients (SOAPP-R). J Addict Med. 2009;3(2):66-73. PMID: 20161199
  7. Butler SF, Fernandez K, Benoit C, Budman SH, Jamison RN. Validation of the revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R). J Pain. 2008;9(4):360-372. PMID: 18203666
  8. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener. Medical Care. 2003;41(11):1284-1292. PMID: 14583691
  9. Center for Quality Assessment and Improvement in Mental Health: PHQ-2 Overview & Screener. 14583691. Accessed November 6, 2017.
  10. Belgrade MJ, Schamber CD, Lindgren BR. The DIRE Score: predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006;7(9):671-681. PMID: 16942953
  11. Portenoy R. Development and testing of a neuropathic pain screening questionnaire: ID Pain. Curr Med Res Opin. 2006;22(8):1555-1565. PMID: 16870080
  12. 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
  13. Butler SF, Budman SH, Fernandez KC, et al. Development and validation of the Current Opioid Misuse Measure. Pain. 2007;130(1-2):144-156. PMID: 17493754
  14. Butler SF, Budman SH, Fanciullo GJ, Jamison RN. Cross validation of the current opioid misuse measure to monitor chronic pain patients on opioid therapy. Clin J Pain. 2010;26(9):770-776. PMID: 20842012