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

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.

Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

“…Retrospective observational studies are valuable research tools for examining epidemiology, disease progression, and treatment effectiveness [4], however, their use is hampered in opioid use disorder (OUD) research due to difficulties in OUD detection in Electronic Health Records (EHR) data. Providers are often reluctant to document concerns about opioid use in health records due to the stigmatizing nature of diagnoses, potential difficulties in future pain management, fear of misclassification, and poorly defined diagnostic criteria [5][6][7][8][9][10]. Therefore, standard approaches for identifying cases in EHR data, such as International Classification of Diseases (ICD) codes or problem lists, insufficiently capture OUD [11][12][13].…”

Perceived risk of opioid use disorder secondary to opioid analgesic medication use by the general population in France

“…the most accepted diagnostic criteria for OUD , some authors (Højsted et al, 2010;Kovatch et al, 2017) debated their use and highlight the importance of addressing specific questionnaire for chronic pain patients. Guidelines recommended the use of simple tools as POMI in primary care settings (Korownyk, Ton, Kolber, Garrison, Thomas, Allan, Bateman, et al, 2019), but some studies failed to validate it in primary care (Masson, 2021) suggesting a room for improvement.…”

Detecting Problematic Opioid Use in the Electronic Health Record: Automation of the Addiction Behaviors Checklist in a Chronic Pain Population

“…5,6 However, ICD codes are not a reliable source of OUD diagnosis because the codes are under-utilized, which has been attributed to OUD-related stigma and provider concerns about barriers to future pain management. 3,[7][8][9][10] Expanding the search to additional areas that contain clinical notes has been explored. For example, Palmer et al used natural language processing (NLP) based on matching terms in a customized dictionary of 1,248 problematic opioid use keywords developed by subject matter experts.…”