Risk Assessment of Opioid Misuse in Italian Patients with Chronic Noncancer Pain

Abstract

Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician's clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach's α = 0.77) and test-retest reliability (r = 0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P < 0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician's evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use.

Cross-cultural adaptation of the Pain Medication Questionnaire for use in Brazil

“…9pt?>Some clinical symptoms related to the adverse effects of opioids, such as constipation and nausea, were similar to those found by [46]. Similarly, the unpredictable recurring vaso-occlusive crises experienced by sickle cell patients were associated with pain in various parts of the body, leading to hospitalization and low quality of life, as observed in other studies [18, 47, 48]. Moreover, insomnia in some patients was related to opioid abuse, probably due to the recurrence of chronic pain in this population [49, 50].…”

“…The original Pain Medication Questionnaire (PMQ) was developed for this study and validated in the USA by (Additional file 1) to assess the risk of opioid abuse in patients with chronic non-oncological pain in a series of four studies [14–17]. However, it was only adapted for Italian [18], and is being submitted to the entire cross-cultural adaptation process in this study, as well as clinical validation in a subsequent investigation, both carried out by the research team. As such, the aims of the present study were to transculturally-adapt and check the content and face validity of the PMQ for use in Brazil.…”

Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain

“…Three studies [57][58][59] were found which compared different tools, as shown in Table 5. The DIRE (diagnosis intractability risk and efficacy) score, included here, was excluded from this review as it was retrospective.…”

Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse

“…Opioid analgesics are the mainstay for pharmacological treatment of chronic moderate-to-severe pain, with their propensity to improve the quality of life. Although there is an agreement on their use in acute and cancer pain, long-term use for CNCP remains controversial [2][3][4][5]. Side effects, absence of any improvement in physical function, misuse, abuse, and addiction are relatively common during chronic opioid use.…”

“…Guidelines recommend that the use of opioids in patients with CNCP must be preceded by an assessment of potential benefits and risks of aberrant drug-related behaviors and should include a psychological and psychiatric assessment [2,10]. Different kinds of tools have been developed for this purpose in recent years [11,12]; Pain Medication Questionnaire [13] and Diagnosis Intractability Risk and Efficacy (DIRE) score [14] were created specifically for chronic pain patients.…”