OBJECTIVES: Many adolescents and young adults report having chronic pain. Urine drug toxicology (UDT) is not routinely used in the pediatric pain management population, despite more routine use in adults with pain, particularly those prescribed opioids. As a first step toward establishing monitoring practices in pediatric and adolescent pain management, the present study evaluated the role of UDT in conjunction with a standard clinical interview in identifying the rate of adherence to an established analgesic regimen. The study also aimed to assess the use of UDT in identifying possible aberrant behaviors in this population. METHODS: Data were acquired from a convenience sample of 50 pediatric and adolescent pain management initial consultations, during which a clinical interview and UDT were conducted. Data were analyzed to determine adherence to an established analgesic prescription regimen, and for identification of aberrant behaviors including concurrent use of illicit substances and prescription medication misuse. Other pertinent demographic and clinical factors were examined as factors in adherence. RESULTS: Opioid medications were prescribed for 42% of the sample receiving pain medications, and 22% of the sample was nonadherent to their prescription analgesic regimen. Factors associated with a higher likelihood of nonadherence were an older age and having an opioid prescription. The majority (90%) of those nonadherent to their analgesic regimen displayed some form of aberrant behavior. Among the nonadherent patients, 50% were identified by UDT alone, and 50% were identified by self-report during the clinical encounter. CONCLUSIONS: These results highlight the challenges of identifying nonadherence to a prescription regimen among adolescents with chronic pain. In addition, this preliminary work suggests that UDT could be used in conjunction with careful clinical interviewing to substantiate patient report and increase the likelihood of detecting analgesic nonadherence and aberrant behaviors.
OBJECTIVES: Many adolescents and young adults report having chronic pain. Urine drug toxicology (UDT) is not routinely used in the pediatric pain management population, despite more routine use in adults with pain, particularly those prescribed opioids. As a first step toward establishing monitoring practices in pediatric and adolescent pain management, the present study evaluated the role of UDT in conjunction with a standard clinical interview in identifying the rate of adherence to an established analgesic regimen. The study also aimed to assess the use of UDT in identifying possible aberrant behaviors in this population. METHODS: Data were acquired from a convenience sample of 50 pediatric and adolescent pain management initial consultations, during which a clinical interview and UDT were conducted. Data were analyzed to determine adherence to an established analgesic prescription regimen, and for identification of aberrant behaviors including concurrent use of illicit substances and prescription medication misuse. Other pertinent demographic and clinical factors were examined as factors in adherence. RESULTS: Opioid medications were prescribed for 42% of the sample receiving pain medications, and 22% of the sample was nonadherent to their prescription analgesic regimen. Factors associated with a higher likelihood of nonadherence were an older age and having an opioid prescription. The majority (90%) of those nonadherent to their analgesic regimen displayed some form of aberrant behavior. Among the nonadherent patients, 50% were identified by UDT alone, and 50% were identified by self-report during the clinical encounter. CONCLUSIONS: These results highlight the challenges of identifying nonadherence to a prescription regimen among adolescents with chronic pain. In addition, this preliminary work suggests that UDT could be used in conjunction with careful clinical interviewing to substantiate patient report and increase the likelihood of detecting analgesic nonadherence and aberrant behaviors.
Authors: Laura P Richardson; Joan E Russo; Wayne Katon; Carolyn A McCarty; Andrea DeVries; Mark J Edlund; Bradley C Martin; Mark Sullivan Journal: J Adolesc Health Date: 2012-02-28 Impact factor: 5.012
Authors: Laxmaiah Manchikanti; Salahadin Abdi; Sairam Atluri; Carl C Balog; Ramsin M Benyamin; Mark V Boswell; Keith R Brown; Brian M Bruel; David A Bryce; Patricia A Burks; Allen W Burton; Aaron K Calodney; David L Caraway; Kimberly A Cash; Paul J Christo; Kim S Damron; Sukdeb Datta; Timothy R Deer; Sudhir Diwan; Ike Eriator; Frank J E Falco; Bert Fellows; Stephanie Geffert; Christopher G Gharibo; Scott E Glaser; Jay S Grider; Haroon Hameed; Mariam Hameed; Hans Hansen; Michael E Harned; Salim M Hayek; Standiford Helm; Joshua A Hirsch; Jeffrey W Janata; Alan D Kaye; Adam M Kaye; David S Kloth; Dhanalakshmi Koyyalagunta; Marion Lee; Yogesh Malla; Kavita N Manchikanti; Carla D McManus; Vidyasagar Pampati; Allan T Parr; Ramarao Pasupuleti; Vikram B Patel; Nalini Sehgal; Sanford M Silverman; Vijay Singh; Howard S Smith; Lee T Snook; Daneshvari R Solanki; Deborah H Tracy; Ricardo Vallejo; Bradley W Wargo Journal: Pain Physician Date: 2012-07 Impact factor: 4.965
Authors: C W Perquin; A A Hazebroek-Kampschreur; J A Hunfeld; L W van Suijlekom-Smit; J Passchier; J C van der Wouden Journal: Clin J Pain Date: 2000-09 Impact factor: 3.442
Authors: Roger Chou; Gilbert J Fanciullo; Perry G Fine; Jeremy A Adler; Jane C Ballantyne; Pamela Davies; Marilee I Donovan; David A Fishbain; Kathy M Foley; Jeffrey Fudin; Aaron M Gilson; Alexander Kelter; Alexander Mauskop; Patrick G O'Connor; Steven D Passik; Gavril W Pasternak; Russell K Portenoy; Ben A Rich; Richard G Roberts; Knox H Todd; Christine Miaskowski Journal: J Pain Date: 2009-02 Impact factor: 5.820
Authors: Barth L Wilsey; Scott M Fishman; Alexander Tsodikov; Christine Ogden; Ingela Symreng; Amy Ernst Journal: Pain Med Date: 2008-02-05 Impact factor: 3.750