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Comparative Study
. 2017 Dec;26(4):e1542.
doi: 10.1002/mpr.1542. Epub 2016 Oct 23.

Evaluation and comparison of tools for diagnosing problematic prescription opioid use among chronic pain patients

Merav Kovatch  1 , Daniel Feingold  2   3 , Odelia Elkana  1 , Shaul Lev-Ran  4   3
Affiliations
Comparative Study

Evaluation and comparison of tools for diagnosing problematic prescription opioid use among chronic pain patients

Merav Kovatch et al. Int J Methods Psychiatr Res. 2017 Dec.

Abstract

Prescription opioid medications are commonly used for the treatment of chronic pain. Assessments of problematic opioid use among pain patients are inconsistent across studies, partially due to differences between various measures. Therefore, the most appropriate measure to use is often unclear. In this study we assessed problematic opioid use in a sample of 551 individuals receiving treatment for chronic pain, using three questionnaires: the Alcohol Use Disorder and Associated Disabilities Interview Schedule - Fourth Edition (AUDADIS-IV), the Current Opioid Misuse Measure (COMM) questionnaire and Portenoy's criteria (PC). These questionnaires yielded discordant positive rates of problematic use: 52.6%, 28.7%, and 17.1%, respectively, which did not change substantially when excluding AUDADIS-IV criteria of physical symptoms of tolerance and withdrawal. Although these three questionnaires share some statistically correlated content-based congruent questions, positive response rates to them were significantly different based on construction features, including questionnaires' referred time-frame, wording of questions and response alternatives. The findings of the present study illustrate strengths and limitations of the AUDADIS-IV, COMM and PC in diagnosing problematic opioid use in a population of adults suffering from chronic pain, and highlight the importance of recognizing and addressing specific questionnaire and question-related differences when identifying problematic opioid use in this population.

Keywords: chronic pain; opioid; prevalence; problematic use; questionnaires.

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Figures

Figure 1
Figure 1
Prevalence of problematic use of prescription opioids among individuals suffering from chronic pain, as diagnosed according to: the Alcohol Use Disorder and Associated Disabilities Interview Schedule – Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (AUDADIS‐IV), Current Opioid Misuse Measure (COMM), and Portenoy's Criteria (PC)
Figure 2
Figure 2
Differences in response rates to content‐based congruent questions from Portenoy's Criteria (PC; X axis) and the Current Opioid Misuse Measure (COMM; represented in bars), which refer to manipulation of the medical system in order to obtain opioids
Figure 3
Figure 3
Differences in response rates to content‐based congruent questions from the Alcohol Use Disorder and Associated Disabilities Interview Schedule – Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (AUDADIS‐IV; X axis) and the Current Opioid Misuse Measure (COMM; represented in bars), which refer to worrying about drug availability
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