Single question test to determine opioid abuse

Accreditation Insider, June 7, 2016

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At the American Pain Society’s (APS) 35th Annual Scientific Meeting, researchers unveiled a new screening tool for opioid abuse risks that involves asking patients one question. It’s called the Catastrophizing Subscale from the Single Item Form of the Coping Strategies Questionnaire (CSQ3 Catastrophizing Subscale).

“Catastrophizing” is when someone believes that something is far worse than it actually is; in this case, their pain symptoms. The questionnaire is one question long and asks patients to rate their agreement with the following statement from 0 (not at all) to 4 (all the time) regarding their pain: "It is terrible and I feel it is never going to get better."

"Catastrophizing is associated with a lot of bad outcomes, including increased pain and risk of opioid abuse, and previous research has identified that one item as being nearly as strong as all of the other items put together in indicating catastrophizing," said study author Richard Gross, PhD, in an interview with Medscape Medical News. "So we wanted to see if use of that one item could represent a quick and easy screening method with clinical utility in places like primary care practices, spine centers, or orthopedic surgery centers, where clinicians can be alerted of the potential for abuse if the score is high."

The study compared data from 119 patients who’d been screened for possible long-term opioid therapy. The CSQ3 results were found to be a strong predictor for abuse on the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), a proven tool for predicting prescription opioid abuse. Results from the study showed that CSQ3’s area under the receiver operator curve (AUC) was 0.72. The AUC is used to measures a model’s ability to predict binary outcomes, and CSQ3’s score implies a large predictive ability.

"The use of the item could be particularly useful in places like spine centers, where long questionnaires are needed for many other aspects of pain-related disability and surgeons may want an alternative to a 13-item measure of catastrophizing," Gross says.

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