The best magazine
The Addiction Behaviors Checklist: Validation of a New Clinician-Based Measure of Inappropriate Opioid Use in Chronic Pain
This viewpoint offers commentary on important clinical research.
Wu S.M., Compton P., Bolus R., et al
J Pain Symptom Manage. 2006;32:342-351
Study Summary
Because of the need to provide effective pain relief in patients with chronic pain, it is difficult to distinguish addictive disease in these patients. Definitions for addiction in chronic pain patients are provided in a consensus statement developed by the American Academy of Pain, the American Pain Society, and the American Society of Addiction Medicine. Descriptors of addiction include impaired control over drug use, compulsive use, continued use despite harm, and craving of the drug.
Behaviors suggestive of addiction have also been described: inability to adhere to the prescription schedule, insistence on certain forms or routes of medication, and resistance to nonopioid treatments. Other activities are considered deviant drug-related behaviors, such as selling prescription drugs, forging prescriptions, stealing drugs, injecting oral formulations, obtaining drugs from nonmedical sources, concurrently abusing alcohol or other drugs, evidence of deterioration in function, and failing to comply with the dosing regimen (eg, losing medications and/or seeking medications from an alternate source). Further research has suggested that patients who believe that they need a higher dose of medication than prescribed, those who report difficulty getting medication they need from a prescriber, and those who worry that they may be too dependent on a medication are more likely to suffer addiction.
The Addiction Behaviors Checklist (ABC), a brief 20-item instrument, was developed to provide clinicians with a tool to monitor behaviors characteristic of addiction in patients with chronic pain who receive opioid analgesics on an ongoing basis. The tool is consistent with the definition of addiction in the consensus statement. This study was undertaken to introduce the tool, examine interrater reliability, examine indicators for validity, and introduce results regarding sensitivity and specificity. All 153 participants (mean age, 53 years) were veterans who were recruited from a chronic pain clinic at a Veterans Affairs Healthcare System. Most of the subjects were male (128 male, 8 female).
Strong interrater reliability was shown when the ABC scores were examined. A correlation between item responses and provider global judgment of problematic opioid use was evident on 14 of the 20 items. Mean ABC scores were higher for inappropriate users than for appropriate users (P < .001). A cutoff score of 3 or greater on the ABC was considered optimal for sensitivity and specificity. No significant correlation between pain scores and ABC scores was evident. The authors suggest that this could indicate that increases in ABC scores are suggestive of addiction.
Viewpoint
Prescribing and dispensing chronic pain therapy often generates concern for healthcare providers, as the entire pain experience is subjective. Tools that can assist the healthcare provider in distinguishing appropriate behaviors from problematic ones may help allay some of those fears. The results from this small study in a well-defined population suggest that this tool can help identify misuse of chronic opioid therapy.
The introduction of tools such as this one can be helpful in the management of chronic pain, especially in those patients with poorly defined pain syndromes. Additional study of this instrument is needed to determine whether its reliability holds when used in a wider population that includes more women and a wider range of patients. Obviously, as with any instrument, it will be best used when combined with clinical judgment. The tool can be useful to flag those patients who warrant closer monitoring of their opioid use.
Abstract
Source: ...