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Single question may predict risk for opioid misuse

A single question that assessed pain catastrophizing — which researchers said was “an exaggerated negative reaction or response to pain, which may include rumination on pain, magnication of the pain experience or consequences of pain, and feelings of helplessness” — was useful in predicting risk for opioid misuse in primary care, according to data recently published in the Journal of the American Board of Family Medicine.

“Whereas comprehensive evaluation of risk is ideal and beneficial in decision making regarding prescribing, there are often strict time constraints or limitations in access to resources than can be preventive to completing such comprehensive evaluations,” Julie Lutz, MS, of the department of psychology at West Virginia University, and colleagues wrote.

Researchers asked 119 patients experiencing chronic pain to complete the Strategies Questionnaire catastrophizing item that asks patients to rank from 0 to 6, with 6 being always, to answer the question: "When I feel pain … It is terrible and I feel it is never going to get any better". Participants were also asked to complete the Pain Catastrophizing Scale and Screener and Opioid Assessment for Patients with Pain – Revised.

Lutz and colleagues found that the catastrophizing item on the Screener and Opioid Assessment for Patients with Pain – Revised showed a fair ability to discriminate those with high risk for opioid misuse (area under the curve = 0.74). The Pain Catastrophizing Scale showed good discrimination (area under the curve = 0.85). The single item alone accounted for 30% of variance in Screener and Opioid Assessment for Patients with Pain – Revised scores. In addition, utilizing the Pain Catastrophizing Scale along with the catastrophizing item led to an area under the curve of 0.86.

“Findings suggest that the single catastrophizing item has utility for predicting risk for opioid medication misuse among chronic pain patients in primary care,” Lutz and colleagues wrote. “Though it does not provide incremental benefit above and beyond the [Pain Catastrophizing Scale], the single item may be used more naturally and efficiently within the context of the clinical interview itself. Using this single question, physicians may quickly identify those at increased risk for opioid misuse and implement strategies to mitigate risk.” – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.