Lynn R Webster1, Rebecca M Webster. 1. Lifetree Pain Clinic and Clinical Research, Salt Lake City, Utah 84106, USA. lynnw@lifetreepain.com
Abstract
OBJECTIVE: To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain. DESIGN: One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool (ORT). The ORT measured the following risk factors associated in scientific literature with substance abuse: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases. Patients received scores of 0-3 (low risk), 4-7 (moderate risk), or >or= 8 (high risk), indicating the probability of their displaying opioid-related aberrant behaviors. All patients were monitored for aberrant behaviors for 12 months after their initial visits. RESULTS: For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behavior. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behavior. The authors used the c statistic to validate the ORT, because it simultaneously assesses sensitivity and specificity. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models. CONCLUSION: In a preliminary study, among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related, aberrant behaviors. Further studies in a variety of pain and nonpain settings are needed to determine the ORT's universal applicability.
OBJECTIVE: To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain. DESIGN: One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool (ORT). The ORT measured the following risk factors associated in scientific literature with substance abuse: personal and family history of substance abuse; age; history of preadolescent sexual abuse; and certain psychological diseases. Patients received scores of 0-3 (low risk), 4-7 (moderate risk), or >or= 8 (high risk), indicating the probability of their displaying opioid-related aberrant behaviors. All patients were monitored for aberrant behaviors for 12 months after their initial visits. RESULTS: For those patients with a risk category of low, 17 out of 18 (94.4%) did not display an aberrant behavior. For those patients with a risk category of high, 40 out of 44 (90.9%) did display an aberrant behavior. The authors used the c statistic to validate the ORT, because it simultaneously assesses sensitivity and specificity. The ORT displayed excellent discrimination for both the male (c = 0.82) and the female (c = 0.85) prognostic models. CONCLUSION: In a preliminary study, among patients prescribed opioids for chronic pain, the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related, aberrant behaviors. Further studies in a variety of pain and nonpain settings are needed to determine the ORT's universal applicability.
Authors: Kathleen W Saunders; Michael Von Korff; Cynthia I Campbell; Caleb J Banta-Green; Mark D Sullivan; Joseph O Merrill; Constance Weisner Journal: J Pain Date: 2012-01-29 Impact factor: 5.820
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Authors: Larry F Chu; John Sun; Anna Clemenson; Matthew J Erlendson; Tom Rico; Erika Cornell; Hannah Obasi; Zahra N Sayyid; Ellen M Encisco; Jeff Yu; Jamison G Gamble; Ian Carroll; J David Clark Journal: J Addict Med Date: 2017 Sep/Oct Impact factor: 3.702