An Opioid Screening Instrument: Long‐Term Evaluation of the Utility of the Pain Medication Questionnaire

Abstract

Abstract:The Pain Medication Questionnaire (PMQ) was designed to assess the risk for opioid medication misuse in chronic pain patients. A preliminary study showed a positive relationship between higher PMQ scores and concurrent measures of substance abuse, psychopathology, and physical/ life-functioning. Using a larger sample size, the present study sought to replicate these findings, and to expand upon them by examining the relationship between PMQ scores and various treatment outcomes. The PMQ was administered to 271 newly evaluated chronic pain patients who were subsequently re-evaluated immediately post-treatment, as well as six months following discharge. Subgroups were then formed according to the lowest (L-PMQ), middle (M-PMQ), and highest (H-PMQ) one-third of PMQ total scores. It was found that the H-PMQ group was 2.6 times more likely to have a known substance-abuse problem, 3.2 times more likely to request early refills of prescription medication, and 2.3 times more likely to drop out of treatment, as compared to the L-PMQ group. They also had diminished biopsychosocial functioning. In addition, at six months following discharge, patients who completed the program experienced a significant decrease in PMQ scores over time relative to those patients who were unsuccessfully discharged from the program or who dropped out. This study represents the second stage in the development of a psychometrically sound screening tool for measuring risk for opioid medication misuse among chronic pain patients, and findings suggest the long-term utility of the PMQ in identifying patients who are more likely to complete and benefit from a pain management program.

Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

“…High risk patients were also found to be less active in managing their pain condition, and to have a greater propensity to produce pessimistic and catastrophic thoughts about their pain symptoms. The association that emerged, between high PMQ scores and the presence of symptoms of depression, appears to be in line with the findings of Holmes et al (2006) in their work assessing the long-term utility of the PMQ in 271 subjects. In this study the low risk patients had mean BDI scores that were significantly lower than those of the high risk of misuse group.…”

Identification and management of pain medication abuse and misuse: current state and future directions

“…Subsequently, in a replication of this initial aforementioned study, Holmes and colleagues revealed some additional important characteristics that were associated with patients with high PMQ score [24]. These characteristics included the following: the request for early refills for prescription medications was 3.2-times more than in patients with low PMQ score; the history of substance abuse problems were 2.6-times greater than in patients with low PMQ score; the dropout rate from an interdisciplinary pain management program was 2.3-times greater than in patients with low PMQ score; and, overall, there was a diminished biopsychosocial functioning level relative to patients with low PMQ score.…”

“…Gatchel and colleagues initially developed the PMQ in order to assess the risk of medication misuse in chronic pain patients in a series of four studies [24,25,29,30]. In the initial study of this series, Adams et al reported that there was a positive relationship between high PMQ scores (high scores = higher potential risk) and concurrent measures of substance abuse, psycho pathology and physical-life functioning [29].…”

“…Psychosocial screening interviews [19], screening tools designed to predict risk for addiction, abuse and misuse [20][21][22][23][24][25], and urine drug screens are used to assess the suitability of patients for long-term opioid treatment. However, few studies have compared the effectiveness of these methods in predicting treatment outcome.…”

Is fear of prescription drug abuse resulting in sufferers of chronic pain being undertreated?

“…A number of assessment tests have been developed for this purpose during recent years [6,9]. For example, the Pain Medication Questionnaire (PMQ) has received a great deal of interest as a result of initial studies by Gatchel and colleagues [12][13][14][15]. The PMQ was initially designed to assess the risk of medication issues in chronic pain patients, and Adams and coworkers found that there was a positive relationship between higher PMQ scores and concurrent measures of substance abuse, psychopathology and physical/life functioning [12].…”