Screening Tools Assessment Scoring Pros Cons
  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
        Derived from validated tests such as MAST and CAGE Not generalizable; sampling bias
        Tobacco abuse as a possible predictor  for active substance abuse No prospective follow up of patients
  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
      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.
      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.
        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
  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
          Patient’s easily categorized into high-risk category
  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
        Greater sensitivity and specificity to prediction score  
        Possible to detect potential risk early and intervene accordingly  
        Distinguish risk groups between high and low risk patients  
  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
      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
        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.
  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
      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
        Distinguishable risk groups between high and low risk patients  
        Prospective follow up of cohort for over 12 months  
        May be concurrently use or complement other documentation tools such as Pain Assessment and Documentation Tool (PADT)  
  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
      Scoring: Probable alcoholism (2+) Completion Time: 30 seconds Widely varying sensitivity based on the cut-off point used
        Simple and easy to use Sensitivity low in elderly and psychiatric population
        Identify life-time prevalence  
        Adapted version to include risk for drug abuse: CAGE-AID  
  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
      Scoring: Indicate alcohol abuse/dependence (6+) High sensitivity Longer completion time: 5 minutes
        High specificity with standard cut-off at 5  
        Different versions of the tool to assess elderly population: MAST-G, SMAST-G  
  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
      Scoring: Indicate alcohol abuse/ dependence (8+) Completion Time: 2-3 minutes  
        Identify active and current alcohol abuse  
        New version AUDIT-5: shown to outperform AUDIT and CAGE in elderly and psychiatric patients  
Table 1: Summary of initial screening tools used for risk assessment to establish addiction status in individuals presenting with chronic pain
Goto home»