Pain Clinicians' Rankings of Aberrant Drug-Taking Behaviors

Abstract

A pilot study was conducted to examine experienced pain physicians' perceptions of aberrant drug taking behaviors. One hundred pain physicians attending a meeting on pain management were asked to rank order (from most aberrant = 1 to least aberrant = 13) a list of aberrant drug-taking behaviors. The sample was comprised mainly of anesthesiologists (50%) and half of the group had 10 or more years of pain management experience. The group prescribed an average of 19-96 opioid medications per week. Practice variables were not related to the rank ordering of the behaviors. All of the various behaviors appeared in all 13 of the rank ordering slots, suggesting a great deal of individual difference in the perception of these behaviors. By examining the average ranking of the behaviors, we noted that physicians' focus on illegal behaviors as the most aberrant followed by the alteration of route of delivery and self-escalation of dose. This survey suggests that an experienced group of pain clinicians does not view aberrant drug related behaviors uniformly. Average rankings suggest clinicians seem to view illegal behavior as the most worrisome. These results must be interpreted with caution due to the small convenience sample, the lack of data on the level of addiction medicine training of the respondents and the lack of data on those physicians who chose not to respond. Further inquiry could be used to guide clinicians' responses to aberrant behaviors when encountered in patients on controlled substances for pain.

Addiction Severity Index in a chronic pain sample receiving opioid therapy

“…These instruments included the Addiction Severity Index (ASI) (McLellan, Kushner, Metzger, Peters, Smith, Grissom, Pettinati, & Argeriou 1992), the Substance Dependence Severity Scale (SDSS) (Miele, Carpenter, Cockerham, Dietz Trautman, Blaine, & Hasin, 2000), a 15-question chronic pain inventory, a prescription medication survey and the 15-question Revised Impact of Events Scale (Horowitz, Wilner, & Alvarez, 1979) Subjects also completed nine questionnaires, including the 44-question P3 scale, which assesses emotional function, (P3 NCS Assessments, 1995) the Treatment Outcomes in Pain Survey (TOPS) which is a modified version of the SF-36, (Pain Management Program and the Health Institute at New England Medical Center, version 2, 1993) the Medical Outcomes Study (MOS) Sleep Cognitive Scale; (Stewart, Ware, Sherbourne, & Wells, 1992) the Neighborhood Disorder Scale (Ross & Mirowsky, 1999); the 14-question Social Strain and Life Stress Scale (Williams, Yu, Jackson, & Anderson, 1997); Aberrant Behavior Items (Passik, Kirsh, Whitcomb, Dickerson, & Theobald, 2002), the SAFTEE (Jacobson, Goldstein, Dominguez, Steinbook, 1987), and a series of questions about utilization of complementary medicine. The findings from these instruments are reported in a series of papers in press or being considered for publication.…”

Providers’ Experiences Treating Chronic Pain Among Opioid-Dependent Drug Users

“…To successfully manage chronic pain with opioids, providers must balance analgesia and restoration of function with the risks of diversion, dependence, and addiction. Variability in opioid prescribing practices may be explained in part by the inherent uncertainty of the opioid risk-benefit equation [6][7][8][9][10] .…”

Patient versus therapist alliance: Whose perception matters?

“…When AMTBs emerge during treatment, they strain the therapeutic relationship. Patients protest that providers are confrontational, withhold opioids and/or treat them like addicts while providers express concern about being manipulated (Passik & Kirsh, 2005;Portenoy, 1996). Negative interchanges make it difficult for a collaborative working relationship to be developed and sustained.…”