Risk of Pain Medication Misuse After Spinal Cord Injury: The Role of Substance Use, Personality, and Depression

Clark, Jillian M.R.; Cao, Yue; Krause, James S.

doi:10.1016/j.jpain.2016.10.011

Cited by 41 publications

(36 citation statements)

References 45 publications

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“…Examination of Rasch-half-point threshold maps and items with mean measures within two standard errors of one another revealed a considerable degree of overlap in the middle of the scale, indicating that item reduction may be possible. In a post hoc analysis, due to the finding that the PMQ separated persons with SCI into two strata, we examined commonly used total score cutoffs of 25 and 30 6,7 in relation to the item difficulty hierarchies produced by Rash analysis. WINSTEPS software provides complete score-to-measure conversion tables and an ogive curve, which allows for the comparison of total scores on an instrument to logit measures (Figure 2).…”

Section: Rasch Analysismentioning

confidence: 99%

“…PMM has been documented in 17-25% of persons with SCI. 6,7 Various factors have been associated with increased risk for PMM in individuals with SCI including: greater reported pain intensity; more limitations in daily activities due to pain; higher frequency of pain medication use; smoking tobacco; cannabis use; anxiety; depressive symptoms; and impulsive sensation-seeking. 6,7 PMM is an important issue for clinical consideration, as it has been associated with higher likelihood of fall-related injuries in ambulatory persons with SCI, 8 as well as fractures, overdose, and myocardial infarction in the general population.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 Various factors have been associated with increased risk for PMM in individuals with SCI including: greater reported pain intensity; more limitations in daily activities due to pain; higher frequency of pain medication use; smoking tobacco; cannabis use; anxiety; depressive symptoms; and impulsive sensation-seeking. 6,7 PMM is an important issue for clinical consideration, as it has been associated with higher likelihood of fall-related injuries in ambulatory persons with SCI, 8 as well as fractures, overdose, and myocardial infarction in the general population. 9 Given that cardiovascular disease is one of the leading causes of mortality 10 and fractures are associated with increased risk of mortality 11 in individuals with SCI, PMM in this population should be carefully monitored.…”

Section: Introductionmentioning

confidence: 99%

“…12 PMQ scores have also demonstrated sensitivity to change over time and have been shown to be predictive of future pain-medication seeking behaviors and early termination from pain medication treatment programs. 13,14 Previous research studies have utilized cutoff values for PMQ total scores 6,7 or have divided total scores into tertiles 14,15 to identify individuals who demonstrate behaviors predictive of PMM. The difficulty with approaches based on total scores is twofold: (1) they assume that the PMQ measures a single, unidimensional construct, and (2) they assume an interval-level scale, which is a prerequisite for additivity of scores.…”

Section: Introductionmentioning

confidence: 99%

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Rasch measurement properties of the Pain Medication Questionnaire in persons with spinal cord injury

2017

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Study design: Secondary analysis of cross-sectional population-based self-report data. Objective: To determine how well the Pain Medication Questionnaire (PMQ) measures risk of pain medication misuse and its precision in separating individuals with spinal cord injury (SCI) into meaningful classification categories. Setting: Academic medical center in Southeastern United States. Methods: Data were collected from a population-based registry of SCI (n = 971). Eligible participants included adults with traumatic SCI with residual effects who were at least 1 year post injury and 18 years of age and who had PMQ data in which they reported active use of pain medication at the time of the study (n = 745). Results: Most items (23/26) of the PMQ contributed to a single unidimensional construct. Rasch analysis results revealed that the rating scale, majority of persons (493%), and majority of items (20/23) fit the Rasch measurement model. The PMQ demonstrated adequate reliability (person reliability = 0.67) and separated persons into two strata-those likely to misuse pain medication and those with low liklihood of misusing pain medication. Conclusions: Findings offer a deeper understanding of the measurement properties of the PMQ as a precursor for widespread population-based studies to elucidate the incidence of pain medication misuse in persons with SCI. Results also have important research and clinical implications for commonly used PMQ total score cut-offs, which may misclassify an individual's risk of pain medication misuse.

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Section: Rasch Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rasch measurement properties of the Pain Medication Questionnaire in persons with spinal cord injury

2017

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“…The question of how to care for patients who receive opioids at high-dose vexes, many physicians caring for patients with spinal cord injury (SCI). Their prevalence of pain is high, with estimates varying from 44 to 67% [1], and opioids are commonly used and misused by this patient population [2].…”

mentioning

confidence: 99%

The drive to taper opioids: mind the evidence, and the ethics

Kertesz

Manhapra²

2018

Spinal Cord Ser Cases

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The high prevalence of pain in patients with spinal cord injury, coupled with a national recalibration of opioid prescribing, presents a challenge. Prescribers may attempt to taper opioids, where observable harms from the prescribed opioid appear to outweigh benefits, a stance endorsed by the 2016 Guideline for Prescribing Opioids for Chronic Pain, issued by the Centers for Disease Control and Prevention. Different considerations apply when clinicians wish to reduce doses in adherent and stable patients, absent their consent. In this perspective piece, we acknowledge the problematic nature of opioids as a treatment. However, forced tapers may destabilize patients and clinical evidence to support forced tapers is lacking. We favor an ethic of informed consent when proposing changes to care involve meaningful risk, and suggest alternative approaches to optimizing safety.

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The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study

Yazdipour

Moshiri

Dadpour

et al. 2022

Health Science Reports

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Background and Aims: Poisoning remains a major health issue in developing countries with high morbidity and mortality rates; also it is one of the most common causes of admission to hospitals. This study aimed to investigate the trend of the top five types of poisonings in hospitalized patients according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) in Imam Reza hospital, Mashhad, Iran.Methods: This was a cross-sectional study performed from March 20, 2012, until September 22, 2018. We collected data from all patients hospitalized for poisoning admitted to the poisoning center at Imam Reza hospital in northeast Iran. ICD-10 was adopted to categorize all types of poisonings (T36-T65). The results obtained were analyzed by SPSS 16.Results: Thirty-four thousand eight hundred and ten cases were included. The mean age of the patients was 29.64 ± 14.69 years, of them, 50.7% were males.Benzodiazepine poisoning (T42.4) has the highest frequency among other subcategories and it was more common among females (60.5%). Opium poisoning (T40.0) has the highest mortality rate (5.4%) among other subcategories that is more common in males (72.0%). The mortality associated with narcotics was the highest frequency (2.7%). Suicide (83.6%) was the most common cause of poisoning. Most poisonings occurred in summer (27.4%). Conclusion:These findings could help health care managers and policymakers develop prevention and educational programs to reduce these poisonings and limit people's easy access to drugs and substances.

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Risk of Pain Medication Misuse After Spinal Cord Injury: The Role of Substance Use, Personality, and Depression

Cited by 41 publications

References 45 publications

Rasch measurement properties of the Pain Medication Questionnaire in persons with spinal cord injury

Rasch measurement properties of the Pain Medication Questionnaire in persons with spinal cord injury

The drive to taper opioids: mind the evidence, and the ethics

The trend of top five types of poisonings in hospitalized patients based on ICD‐10 in the northeast of Iran during 2012–2018: A cross‐sectional study

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