Warning Signs Of Painkiller Abuse

Ed. Note: The following is a press release from Blackwell Publishing.

September 6, 2006 --A recent study of patients receiving opioid (opiate) medications for chronic pain, has confirmed that a number of warning signs may appear in the medication pre-screening process for doctors with concerns over medication-abuse by patients and the long-term effectiveness of the treatment.

The survey was conducted by Robert J. Gatchel, Ph.D., ABPP at the University of Texas at Arlington, using the Pain Medication Questionnaire (PMQ), heralded as a benchmark in patient-screening, in an attempt to accurately identify which patients receiving opioid medication for chronic-pain management would benefit from the drug and which would potentially abuse it. Gatchel hypothesized that patients scoring high on the PMQ test would demonstrate higher levels of physical impairment and psychosocial distress as compared to low scoring patients prior to treatment.

Gatchel's findings largely indicate that the hypothesis was correct. Higher PMQ (H-PMQ) scores correlate with higher levels of substance abuse, psychopathology and physical/life functioning problems amongst patients, as confirmed by the study. Specifically, those scoring within the H-PMQ range are found to be:

  • 3.2 times more likely to request an early refill of medication

  • 2.6 times more likely to have substance abuse history

  • 2.3 times more likely to drop out of the treatment program

Additionally, 51.7% of divorced persons tested fell within the H-PMQ group, as did 51.2% of those receiving disability payments. This suggests that demographic similarities exist across all PMQ groups, making the results easily generalized to the larger population of chronic-pain patients.

A re-evaluation six months after treatment concluded showed that those who completed the program experienced diminishing PMQ scores over time compared to those who dropped out or were unsuccessfully discharged. This represents the second stage in the development of a sound, reliable screening tool for measuring the risk of opioid medication abuse.

The study has widespread implications for policy makers, insurers and pain physicians. Opioid pain-treatment is a standard of care for over 50 million people in the U.S. and accounts for $70 billion annually in healthcare costs and lost productivity. The aim of the study is to promote a more effective use of healthcare dollars and resources.

Robert J. Gatchel is the Chair of the Department of Psychology, College of Science, at The University of Texas at Arlington, as well as the Director of Clinical Research at The Eugene McDermott Center for Pain Management, Department of Anesthesiology & Pain Management, at The University of Texas Southwestern Medical Center at Dallas. He is also a Diplomate of the American Board of Professional Psychology (ABPP). Please direct inquiries to Sue Stevens at: sstevens@uta.edu

Pain Practice , the official journal of World Institute of Pain, publishes international multidisciplinary articles on pain that provide its readership with up-to-date knowledge of the research, evaluation methods, and techniques of pain management. The present literature on pain medicine is diverse and published in a variety of basic and clinical specialty journals. For a practitioner to subscribe to all the venues needed to cover the field of pain medicine would be impractical, if not impossible. Likewise, the literature search can be cumbersome, costly, and entirely unavailable in some areas. As a thorough, multidisciplinary journal, Pain Practice is a convenient, cost-effective way to resolve these dilemmas. Published on behalf of the World Institute of Pain. For more information on membership, please visit http://www.wipain.org/.

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