New Method Helps Doctors Check Pain Drug Compliance

Short Checklist Can Pinpoint Possible Risk Behaviors

CHICAGO, November 25, 2014—Assuring appropriate drug theory is important for effective pain management, and a new study published in The Journal of Pain reported that use of a short compliance checklist by clinicians can best identify individuals most likely to misuse prescription pain medications. The Journal of Pain is the peer-reviewed publication of the American Pain Society, www.americanpainsociety.org.

Researchers at Brigham and Women’s Hospital developed and validated a brief self-administered compliance checklist for long-term opioid therapy in patients with chronic pain. Currently, there are no widely accepted assessments for monitoring ongoing opioid therapy adherence, and few studies have attempted to link self-report variables with objective evidence of prescription drug misuse.

For the study, a 12-item Opioid Compliance Checklist was repeatedly administered to 157 patients taking opioids for chronic pain who participated in the investigation and were followed for six months.

Results showed that five items best predicted subsequent aberrant drug behaviors. They are:

Lost or misplaced medications
Ran out of pain medication early
Missed scheduled doctor appointments
Used any illegal or unauthorized substances
Not been completely honest about personal drug use

Data collected on the sample of patients with chronic pain suggest these five items may be useful in identifying potential for drug misuse and in determining appropriateness of continued treatment.

“We were surprised at how powerfully a brief checklist that reflects how patients comply with parts of an opioid agreement can predict future misuse of opioids,” stated lead author, Robert Jamison, PhD, professor, Departments of Anesthesiology and Psychiatry, Brigham and Women’s Hospital.

Researchers at M.D. Anderson Cancer Center assessed the extent to which pain severity influences survival in 2,340 newly diagnosed patients with head and neck cancer. At first presentation, patients rated their pain using a scale in which 0 meant no pain and 10 indicated “pain as bad as you can imagine.” Survival time was calculated from diagnosis to death or last follow-up.

Head and neck cancer is the sixth most common malignancy worldwide, and squamous cell cancer is the most prevalent head and neck cancer, which include cancers of the oral cavity, tongue, pharynx, and larynx. In the United States, some 54,000 people are diagnosed every year, and five-year survival rates for oral, pharyngeal and laryngeal cancers are 56 percent and 62 percent, respectively.

Pain often is the first sign of head and neck cancer, as a result of destructive lesions and direct tissue and bone involvement. Acute pain from therapy is very common from surgery, chemotherapy and radiation.

Results of the study showed that severe pain was reported by 19 percent of the sample, and was most prevalent in patients with oral cancer (20 percent). Pain intensity varied based on tumor stage, fatigue, smoking status and comorbid lung disease.

Eight hundred twenty eight patients died. Among those with oral cancer, overall five-year survival was 31 percent for patients who reported severe pain and 52 percent for those without severe pain. The survival differentiation was similar in patients with pharyngeal cancer.

The authors concluded that pretreatment pain severity in head and neck cancer patients is an independent predictor of overall five-year survival. They noted that patients who present with severe pain at diagnosis should be closely monitored and promptly treated for pain symptoms.

About the American Pain Society

Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organization. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and others. For more information on APS, visit www.americanpainsociety.org.