Chronic pain is a costly syndrome that influences every aspect of a person’s functioning. Profound changes in quality of life are associated with intractable chronic pain. Significant interference with sleep, employment, social functioning, and daily activities is common. Chronic pain patients frequently report depression, anxiety, irritability, sexual dysfunction, and decreased energy. Chronic pain accounts for 21% of emergency room Visits
and 25% of annual missed work days and, when direct and indirect costs are considered, imposes a greater economic burden than any other disease, with estimates of annual costs adding up to $100 billion in USA. (Frymoyer 85 Cats-Baril, 1991; Maniadakis 8C Gray, 2000). The word “addiction” traditionally incorporates physical, and tolerance. More recently, however, it has become clear that, in the use of opioids for chronic pain, tolerance and physical dependence are common and unrelated to true addiction. Thus, a different definition of addiction has emerged. In this context, addiction is a behavioral pattern of substance abuse characterized by overwhelming involvement With the use of a drug (DSM-IV, APA, 1994; Leshner, 2001a). This definition focuses on compulsive use of the drug that results in physical, psychological, and social harm to the user, who continues despite this harm. As for predicting addiction or prescription abuse potential, the Screening Instrument for Substance Abuse Potential (SISAP; Coambs et al., 1996) is a five item screening measure that is clinician—administered and requires that the clinician know the patient or have collateral information to confirm accuracy of answers. Another measure, the Screening Tool for
Addiction Risk (STAR; Li, 2001), is a 14-item questionnaire recently published as a brief report. While the authors of both measures report that some items differentiate patients currently abusing or not abusing their medications, neither has under gone the prospective testing recommended by Robinson et al. (2001). The Screener and Opioid Assessment for Patients with Pain (SOAPP) Version 1.0 is a tool for clinicians to help determine how much monitoring a patient on long-term opioid therapy might require. Ongoing data collection at the Pain Management Center of Brigham and Women’s Hospital is being conducted to test empirically the reliability and validity of the SOAPP v1. Preliminary results suggest acceptable reliability (coefficient a> .74) and reasonable predictive validity. The SOAPP V1 data, along with other clinical findings, can help the provider determine the level of monitoring that may be necessary to safely prescribe long—term opioid therapy for a given patient. Of the 24 questions contained in the SOAPP version 1.0, 16 have been empirically identified as predicting aberrant medication-related behavior six months after initial testing. A score of 7 or higher is considered positive.
Clinically, a score of 7 or higher will identify 91% of those who actually turn out to be at high risk. The Negative Predictive Values for a cutoff score of 7 is .90, which means that most people who have a negative SOAPP are likely at low-risk. Finally, the Positive likelihood ratio suggests that a positive SOAPP score (at a cutoff of 7) is nearly 3 times (2.94 times) as likely to come from someone who is actually at high risk (note that, of these statistics, the likelihood ratio is least affected by prevalence rates).
[WpProQuiz 13]
