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Screening Tools |
Assessment |
Scoring |
Pros |
Cons |
| Opioids |
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Screening Tool for Addiction Risk (STAR) [2] |
Self- administered survey tool to help identify risk for addiction in chronic pain patient receiving opioids treatment |
14 true-or-false questions |
Self- administered questionnaires |
Does not detect active substance abuse in patient with chronic pain |
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Derived from validated tests such as MAST and CAGE |
Not generalizable; sampling bias |
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Tobacco abuse as a possible predictor for active substance abuse |
No prospective follow up of patients |
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Pain Medication Questionnaire (PMQ) [40] |
An ongoing tool to identify patients on a range of potential risk factors through self-reports of addiction related behaviors |
26 questions represented on a 5-point Likert scale format |
Good reliability and predictive validity |
It is not a diagnostic tool |
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Cut off point at 22 PMQ, suitable to separate between patients at risk |
Prospective follow up in 2 week and retested: results show very strong correlation |
Risk for false positives (56%) at cut-off score of 22. |
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Patient classification: High-PMQ or Low-PMQ groups |
Validity of PMQ was assessed by correlation to Portenoy’s Criteria (PC) |
Not generalizable: Translation and cultural difference between the Danish and American population may require different cut-off points for pain. |
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A strong tool to screen at risk patient, follow up, and intervene to manage therapy |
Samples in the study was a mixture of two pain populations: cancer and non-cancer pain |
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Screener and Opioid Assessment for Patient with Pain (SOAPP) |
A self-reported tool to predict aberrant medication related behaviors among chronic pain patient |
14-item self-reported questionnaire |
N/A |
Scoring difficulties due to only 14-items |
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Patient’s easily categorized into high-risk category |
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Screener and Opioid Assessment for Patient with Pain –Revised (SOAPP-R) [46] |
A risk assessment tool to helps predicts possible opioid abuse in patient with chronic pain |
24-item self- reported questionnaire |
Addressed limitation in original SOAPP |
Tool is not applicable to every population: must be considering long-term therapy with opioids |
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Greater sensitivity and specificity to prediction score |
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Possible to detect potential risk early and intervene accordingly |
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Distinguish risk groups between high and low risk patients |
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Opioid Risk Tool (ORT) [47] |
A self-administered risk assessment tool to help predict aberrant behaviors while on opioids therapy to manage chronic pain |
Potential risk factors were awarded a specific point value based responder’s sex. |
Risk factors comparable to what is found in scientific literature for substance abuse |
Small sample size relative to the number of risk factors |
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The total score used to stratified patient into three risk groups: Low (0-3), Moderate (4-7), and High (> 8) |
Prospective follow up of cohort for 12 months after initial visit. |
Tested in only one clinic site, thus may not be universally applicable |
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Greatly distinguish risk between high and low risk patients, and between males and females |
Clinicians who recorded patient’s aberrant behavior were not blinded to patient’s ORT score. |
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Diagnosis, Intractability, Risk, Efficacy (DIRE) Score [34] |
A risk assessment tool to help identify chronic pain patients at risk for addiction while receiving opioids treatment, and help assess whether patient will remain compliant to long-term opioids therapy |
Scoring criteria consist of four main factors that are broken four subcategorizes |
Strong correlation to compliance |
Selective for primary care setting only to be used by trained clinician |
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Scoring: Not a suitable candidate (7-13), Good candidate (14-21) |
Allows for a rapid assessment of aberrant behavior |
Moderate correlation to efficacy reported in study |
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Distinguishable risk groups between high and low risk patients |
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Prospective follow up of cohort for over 12 months |
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May be concurrently use or complement other documentation tools such as Pain Assessment and Documentation Tool (PADT) |
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| Alcohol |
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CAGE Assessment [48] |
A screening tool for alcohol use disorders (AUD) |
4-item questionnaire: Cut down, Annoyed, Guilty, Eye-Opener |
May be self-administered |
Does not differentiate between past and active alcohol abuse |
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Scoring: Probable alcoholism (2+) |
Completion Time: 30 seconds |
Widely varying sensitivity based on the cut-off point used |
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Simple and easy to use |
Sensitivity low in elderly and psychiatric population |
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Identify life-time prevalence |
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Adapted version to include risk for drug abuse: CAGE-AID |
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Michigan Assessment Screening Test (MAST) [48] |
A screening tool for alcohol abuse/dependence and hazardous drinking |
22-item questionnaire awarded specific point value based on yes or no response |
Identify life-time prevalence |
Varying specificity when cut off score lower than 5 |
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Scoring: Indicate alcohol abuse/dependence (6+) |
High sensitivity |
Longer completion time: 5 minutes |
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High specificity with standard cut-off at 5 |
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Different versions of the tool to assess elderly population: MAST-G, SMAST-G |
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Alcohol Use Disorder Identification Test (AUDIT) [48] |
A screening tool for alcohol abuse/dependence and hazardous drinking |
10-item questionnaire awarded specific point value |
May be self-administered |
AUDIT is less effective in elderly population |
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Scoring: Indicate alcohol abuse/ dependence (8+) |
Completion Time: 2-3 minutes |
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Identify active and current alcohol abuse |
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New version AUDIT-5: shown to outperform AUDIT and CAGE in elderly and psychiatric patients |
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