The American Academy of Pain Medicine      Annual Meeting Home Page     
23rd Annual Meeting
February 7-10, 2007
New Orleans, LA
© 2006 American Academy of Pain Medicine
 


Thursday, February 8, 2007
151

Psychiatric History and Psychological Adjustment as Risk Factors for Aberrant Drug-related Behavior among Patients with Chronic Pain

Ajay D. Wasan, MD, MSc1, SF Butler, PHD2, SH Budman2, K Fernandez2, and Rn Jamison1. (1) Harvard Medical School/Brigham and Women's Hospital, Chestnut Hill, MA, USA, (2) Inflexxion Inc., Newton, MA, USA

Objective: In prescribing opioids for chronic noncancer pain, we have little understanding of which patients are likely to be compliant with therapy. We investigated the impact of psychiatric history and current psychological adjustment on aberrant drug-related behavior among patients prescribed opioids for noncancer pain.

Methods: With IRB approval, this multicenter, prospective cohort study enrolled 228 patients prescribed opioids for chronic pain. They were classified as either high or low on psychiatric morbidity on the basis of their responses on the psychiatric subscale of the Prescription Drug Use Questionnaire (PDUQ). They also completed the Brief Pain Inventory, Screener and Opioid Assessment for Pain Patients (SOAPP), and the Current Medication Misuse Measure (COMM). Patients were followed for five months and submitted a urine toxicology screen (month 4 or 5), and their treating physician completed the Prescription Opioid Therapy Questionnaire (POTQ), which rates opioid misuse behaviors. Based on results from the SOAPP, COMM, POTQ and urine screens, patients were classified as positive or negative on the Aberrant Drug Behavior Index (ADBI).

Results: 103 patients (45%) were classified in the low psychiatric group (Low Psych) while 55% (N=125) were classified in the high psychiatric morbidity group (High Psych). High Psych patients were significantly younger than Low Psych patients and had been taking opioids longer (p<0.05). The High Psych group showed significantly higher SOAPP and COMM scores than the Low Psych patients (p<0.001), a greater frequency of abnormal urine toxicology screens (p<0.01), and significantly higher scores on the ADBI (p<0.001).

Discussion: Psychiatric factors, such as a history of mood disorder, psychological problems, and psychosocial stressors, may place patients at risk for misuse of prescription opioids. Future studies to elucidate the risk of medication misuse and aberrant drug behavior among this patient population are needed, which will lead to interventions to improve opioid compliance.


References: Schofferman J. Long-Term Use of Opioid Analgesics for the Treatment of Chronic Pain of non-Malignant Origin. J Pain Symp Management 1993;8:279-288.

Compton PJ, Darakjian J, Miotto K. Screening for Addiction in Patients with Chronic Pain and 'Problematic' Substance Use: Evaluation of a Pilot Assessment Tool. J Pain Symptom Manage 1998;16:355-63.

Heit, H. A. and D. L. Gourlay (2004). "Urine Drug Testing in Pain Medicine." J Pain Symptom Manage 27(3): 260-267.


Funding: NIH, Natl. Inst. Drug Abuse

Ajay D. Wasan, MD, MSc
Nothing to disclose.

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