Three additional tools have been validated only among pain clinic patients
The ABC was developed based on literature review and validated against the PDUQ and clinician judgment of opioid misuse. Scores on the ABC differed significantly between patients who were discontinued from opioid therapy (based on urine toxicology, for example) and patients who weren’t (P=.021).4
The authors of the POMI determined sensitivity and specificity by comparing the POMI with DSM-IV diagnostic criteria for opiate addiction. One weakness of this index is that it is based on a small, homogenous sample.5
Items in the PDUQ were based on a literature review and extracts from the charts of patients with chronic pain.6
Additional reviews
Two systematic reviews of screening tools used to predict aberrant behaviors in pain center populations included several studies with methodologic limitations.7,8
RECOMMENDATIONS
A guideline from the American Pain Society based on a systematic review concluded that the most predictive factor for aberrant drug-related behaviors is a personal or family history of drug or alcohol abuse.9,10 In 2009, APS and American Academy of Pain Medicine developed guidelines to assist in selecting, risk-stratifying, and monitoring patients on chronic pain medication.9,10 The American Society of Interventional Pain Physicians recommends evaluation of misuse risk, but considers screening tools an optional measure during initial assessment for opioid prescribing.11