Skala et al reported a questionnaire which can help to identify a pain patient who may be at increased risk for developing opioid addiction. This can help to identify a patient who may require more aggressive management or nonopioid therapy. The authors are from the Medical University of Vienna.
Patient selection: patient with pain
Sections:
(1) nicotine addiction (heavy smoking index)
(2) alcohol dependence using the CAGE questionnaire
(3) psychiatric history
(4) expected effect of analgesic medication
(5) attribution of pain origin
|
Parameter |
Finding |
Points |
|
time to first cigarette after waking up |
<= 5 minutes |
3 |
|
|
6 to 30 minutes |
2 |
|
|
31 to 60 minutes |
1 |
|
|
> 60 minutes |
0 |
|
cigarettes smoked per day |
> 30 |
3 |
|
|
21 to 30 |
2 |
|
|
11 to 20 |
1 |
|
|
<= 10 |
0 |
|
need to cut down drinking (CAGE 1) |
no |
0 |
|
|
yes |
1 |
|
annoyed by people criticizing your drinking (CAGE 2) |
no |
0 |
|
|
yes |
1 |
|
ever felt guilty about drinking (CAGE 3) |
no |
0 |
|
|
yes |
1 |
|
ever needed a drink first thing in the morning (CAGE 4) |
no |
0 |
|
|
yes |
1 |
|
family history of psychiatric illness or addiction (Psyche 1) |
no |
0 |
|
|
yes |
1 |
|
psychological strain or cerebral disorder before the age of 14 that had a negative impact on development (Psyche 2) |
no |
0 |
|
|
yes |
1 |
|
ever suffered from depression or anxiety (Psyche 3) |
no |
0 |
|
|
yes |
1 |
|
past or current evidence of drug abuse or addiction (Psyche 4) |
no |
0 |
|
|
yes |
1 |
|
think that a drug can make you happier, more content or more self-secure (Drug 1) |
no |
0 |
|
|
yes |
1 |
|
think that a drug can help you unwind or reduce stress (Drug 2) |
no |
0 |
|
|
yes |
1 |
|
primary cause of pain |
due to organ damage or injury |
0 |
|
|
due to psychological reasons |
1 |
subscore for nicotine addiction =
= SUM(points for 2 smoking quesitons)
subscore for alcohol dependence =
= SUM(points for the 4 CAGE questions)
subscore for psychiatric history =
= SUM(points for the 4 psychiatric questions)
subscore for expected effect of analgesic medicine =
= SUM(points for the 2 drug questions)
Interpretation - there is a risk of addiction if:
(1) the nicotine addiction subscore is >= 4.
(2) the alcohol dependence subscore is >= 2.
(3) the psychiatric history subscore is >=1.
(4) the expected effect of the medication subscore is >=1.
(5) the points for the primary cause of pain is 1.
Specialty: Pharmacology, clinical
