(195) The feasibility and value of using the SOAPP®-R to predict substance abuse in an outpatient pain clinic

Eichorn, D.; Lesenskyj, Alexandra M.; Maxwell, Christopher D.; Moore, Steven; Cruciani, Ricardo A.

doi:10.1016/j.jpain.2016.01.098

Cited by 5 publications

(1 citation statement)

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“…There are important clinical correlations that should provide the pharmacodynamic dimension for assessing opioid tolerance and dependence. Validated patient outcomes tools for pain management include the PEG-3 (Pain, Enjoyment, General Activity) Scale, COMM-9 (Current Opioid Misuse Measure), and SOAPP (Screener and Opioid Assessment for Patients with Pain) (34)(35)(36)(37). As with all clinical symptoms, these represent the environmental modifiers.…”

Section: Gene-environment Interactionsmentioning

confidence: 99%

Fundamental Considerations for GeneticallyGuided Pain Management with Opioids Based on CYP2D6 and OPRM1 Polymorphisms

Ruaño

2018

Pain Phys

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Background: A major challenge for effective pharmacotherapy in pain management is to provide the drug best suited to the patient’s innate characteristics. Objective: The article illustrates pharmacogenetic principles to optimize treatments for patients and increase the likelihood of pain relief without dependence. Genetic variances are particularly relevant to opioid drugs used in pain control, and can now be harvested for predictive clinical decision support. Study Design: Clinically actionable polymorphisms in CYP2D6 (cytochrome p450 2D6) and OPRM1 (μ1 opioid receptor), the most important gene coding, respectively, for a metabolizing enzyme and receptor for opioids are reviewed, and functional effects described. Methods: Risk of dysfunction is calculated from the frequency of the alleles with null function for CYP2D6, and from the low function polymorphism for OPRM1. Integration of genetic variability was performed for 9 combinatorial scenarios for CYP2D6 and OPRM1. Each combination was quantified in frequency and classified for clinical impact. A rational and pharmacological basis for personalized pain management based on pharmacokinetic and pharmacodynamic modeling is extracted from the frequency of the combinations. Results: Patients can be classified in 3 broad risk categories for opioid side effects and dependence. Patients at high-risk with dysfunctional CYP2D6 or OPRM1 account for ~14% of the population and are best managed with non-opioids. Patients at medium risk with subnormal CYP2D6 or OPRM1 account for ~48% of the population and can be managed with dose monitoring. Patients at low risk with functional CYP2D6 and OPRM1 account for ~38% of the population and should be availed to opioid therapy. Limitations: Heuristic clinical decision support considerations are not validated yet by deployment in large clinical practices. Environmental modifiers such as other drugs and dietary supplements interact with innate characteristics to modify the genetic predictions. Conclusion: Through clinical decision support interpreting the genotyping data, drug choices and doses can then be tailored to provide safe and effective therapy for individual patients. This precision affords personalized medicine to be practiced in pain treatment. Genetic factors could help determine why some patients seem more vulnerable than others to opioid side effects and dependence. Key words: Pain management, opioids, CYP2D6, OPRM1, clinical decision support, pharmacokinetics, pharmacodynamics, pharmacogenetics, combinatorial genotypes

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Section: Gene-environment Interactionsmentioning

confidence: 99%

Fundamental Considerations for GeneticallyGuided Pain Management with Opioids Based on CYP2D6 and OPRM1 Polymorphisms

Ruaño

2018

Pain Phys

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Safe Opioid Prescribing and Controlled Substance Policies

Tobin

Barrette²

2017

Leading an Academic Medical Practice

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Detecting aberrant opioid behavior in the emergency department: a prospective study using the screener and Opioid Assessment for Patients with Pain-Revised (SOAPP®-R), Current Opioid Misuse Measure (COMM)™, and provider gestalt

et al. 2018

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Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients' opioid misuse risk. We performed variable-centered, person-centered, and hierarchical cluster analyses to determine whether provider gestalt, SOAPP-R, or COMM, or a combination, predicted higher misuse risk. The primary outcome was the number of opioid prescriptions at 12 months according to pharmacy records. For 169 patients (mean age 43 years, 51% female, 73% white), correlation analysis showed a strong relationship between SOAPP-R and COMM with predicting the number of opioid prescriptions dispensed at 12 months. Provider scores estimating opioid misuse were not related to SOAPP-R and only weakly associated with COMM. In our adjusted regression models, provider gestalt and SOAPP-R uniquely predicted opioid prescriptions at 6 and 12 months. Using designated cutoff scores, only SOAPP-R detected a difference in the number of opioid prescriptions. Cluster analysis revealed that provider gestalt, SOAPP-R, and COMM scores jointly predicted opioid prescriptions. Provider gestalt and self-report instruments uniquely predicted the number of opioid prescriptions in ED patients. A combination of gestalt and self-assessment scores can be used to identify at-risk patients who otherwise miss the cutoff scores for SOAPP-R and COMM.

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(195) The feasibility and value of using the SOAPP®-R to predict substance abuse in an outpatient pain clinic

Cited by 5 publications

References 0 publications

Fundamental Considerations for GeneticallyGuided Pain Management with Opioids Based on CYP2D6 and OPRM1 Polymorphisms

Fundamental Considerations for GeneticallyGuided Pain Management with Opioids Based on CYP2D6 and OPRM1 Polymorphisms

Safe Opioid Prescribing and Controlled Substance Policies

Detecting aberrant opioid behavior in the emergency department: a prospective study using the screener and Opioid Assessment for Patients with Pain-Revised (SOAPP®-R), Current Opioid Misuse Measure (COMM)™, and provider gestalt

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