K. Zacharoff

A Randomized Trial of a Web-based Intervention to Improve Migraine Self-Management and Coping

Objective.— To test the clinical efficacy of a web‐based intervention designed to increase patient self‐efficacy to perform headache self‐management activities and symptom management strategies, and reduce migraine‐related psychological distress.

Shortening the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study for Customized Computer-Based Testing

BACKGROUND The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item self-report instrument that was developed to aid providers in predicting aberrant medication-related behaviors among chronic pain patients. Although the SOAPP-R has garnered widespread use, certain patients may be dissuaded from taking it because of its length. Administrative barriers associated with lengthy questionnaires further limit its utility. OBJECTIVE To investigate the extent to which two techniques for computer-based administration (curtailment and stochastic curtailment) reduce the average test length of the SOAPP-R without unduly affecting sensitivity and specificity. DESIGN Retrospective study. SETTING Pain management centers. SUBJECTS Four hundred and twenty-eight chronic non-cancer pain patients. METHODS Subjects had taken the full-length SOAPP-R and been classified by the Aberrant Drug Behavior Index (ADBI) as having engaged or not engaged in aberrant medication-related behavior. Curtailment and stochastic curtailment were applied to the data in post-hoc simulation. Sensitivity and specificity with respect to the ADBI, as well as average test length, were computed for the full-length test, curtailment, and stochastic curtailment. RESULTS The full-length SOAPP-R exhibited a sensitivity of 0.745 and a specificity of 0.671 for predicting the ADBI. Curtailment reduced the average test length by 26% while exhibiting the same sensitivity and specificity as the full-length test. Stochastic curtailment reduced the average test length by as much as 65% while always exhibiting sensitivity and specificity for the ADBI within 0.035 of those of the full-length test. CONCLUSIONS Curtailment and stochastic curtailment have potential to improve the SOAPP-Rs efficiency in computer-based administrations.

Identifying Primary Care Skills and Competencies in Opioid Risk Management.

Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of pain. The objective of this study was to identify which skills and competencies are most critical for PCPs in order to effectively manage opioid risk in patients treated for chronic pain. Methods: We conducted 1‐hour interviews with 16 nationally known experts in primary care, pain management, and addiction. Eight were trained as PCPs, and 8 were trained as specialists. Their responses were collated and then presented online to the participants for independent sorting and rating. These data were analyzed using an online concept mapping program, which offers an innovative method of summarizing and prioritizing qualitative data. Results: Based on this analysis, items were organized into 10 clusters representing the most critical categories of skills (the “best fit” for these data). The cluster that received the highest average statement rating was “How to Manage Pain Patients With Comorbid Conditions.” Follow‐up analyses indicated that specialists rated this cluster, and 5 others, significantly higher than the PCPs, suggesting that the specialists perceive these competencies as more important in opioid risk management. Discussion: Using a relatively small sample and cost‐effective technique (ie, concept mapping), key PCP competencies can be identified for potential inclusion in continuing education and training in opioid risk management.

Development of Short-Form Versions of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study

Background The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item questionnaire designed to assess risk of aberrant medication-related behaviors in chronic pain patients. The introduction of short forms of the SOAPP-R may save time and increase utilization by practitioners. Objective To develop and evaluate candidate SOAPP-R short forms. Design Retrospective study. Setting Pain centers. Subjects Four hundred and twenty-eight patients with chronic noncancer pain. Methods Subjects had previously been administered the full-length version of the SOAPP-R and been categorized as positive or negative for aberrant medication-related behaviors via the Aberrant Drug Behavior Index (ADBI). Short forms of the SOAPP-R were developed using lasso logistic regression. Sensitivity, specificity, and area under the curve (AUC) of all forms were calculated with respect to the ADBI using the complete data set, training-test analysis, and 10-fold cross-validation. The coefficient alpha of each form was also calculated. An external set of 12 pain practitioners reviewed the forms for content. Results In the complete data set analysis, a form of 12 items exhibited sensitivity, specificity, and AUC greater than or equal to those of the full-length SOAPP-R (which were 0.74, 0.67, and 0.76, respectively). The short form had a coefficient alpha of 0.76. In the training-test analysis and 10-fold cross-validation, it exhibited an AUC value within 0.01 of that of the full-length SOAPP-R. The majority of external practitioners reported a preference for this short form. Conclusions The 12-item version of the SOAPP-R has potential as a short risk screener and should be tested prospectively.

Electronic Opioid Risk Assessment Program for Chronic Pain Patients: Barriers and Benefits of Implementation

A preliminary electronic pain assessment program known as Pain Assessment Interview Network, Clinical Advisory System (painCAS), was implemented in 2 pain centers over the course of 10 months to understand the tools impact on opioid risk assessment documentation and clinical workflow. The program contains validated electronic versions of screeners for opioid misuse risk (SOAPP‐R and Current Opioid Misuse Measure).

(128) What does pain treatment look like in the real world? Utility of the PainCAS dataset

The Pain Assessment Interview Network – Clinical Advisory System (PainCAS ) is a comprehensive, electronic assessment of patients during pain-related treatment. As part of the clinic workflow, PainCAS collects patient self-report at intake and follow-up visits on pain, medical/family history, medications and other treatments, social and emotional functioning, and opioid risk; generating reports for providers and patients. De-identified data are uploaded and analyzed in real time. By October 2015, 4,795 assessments were collected at 18 clinics in 16 states; 73% from unique patients. Follow-up visits ranged from 2 visits to 11, suggesting potential for tracking outcomes. Most patients (60%) were female, white (80%) and 45 to 64 years old (51%). Back/neck pain was reported most (70%), followed by hip/leg pain (46%), shoulder/arm (24%), head (10%) and front torso (8%), with 25% reporting more than one body area. Mean pain rating for past-week-average was 6.2, worst-8.2, and least-4.9 (0 – 10). At first assessment, 14% reported no past pain treatment, 71% reported physical treatment, 18% mental health treatment, 48% past interventions treatments, and 30% reported past surgeries. Surgeries were rated as most helpful/ very helpful (42%), followed by mental health treatment (29%), interventional (28%), and physical therapy (18%). 86% reported currently taking medications for pain at first assessment, and at follow-up, 13% reported changing medications since last visit. The most reported medication-related side effects were fatigue (31%), dry mouth (29%), constipation (22%), drowsiness (18%) and sweating (13%). Most reported comorbid conditions were anxiety (34%), hypertension (34%), depression (28%) and elevated cholesterol (22%). 25% of patients had a positive SOAPP score for opioid risk. Pain interfered most often with daily chores (78%), sleeping (71%), ability to move (68%), be active/exercise (67%), and work/ school (56%). PainCAS data such as these can address many questions regarding pain, its presentation, treatments and outcomes in the real world.

(196) A proof of concept for short forms of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R)

Physicians remain reluctant to prescribe opioid medication because of concerns about addiction, misuse, and other aberrant medication-related behaviors, as well as liability and censure concerns. Despite recent findings suggesting that most patients are able to successfully remain on long-term opioid therapy without significant problems, physicians often express a lack of confidence in their ability to distinguish patients likely to have few problems on long-term opioid therapy from those requiring more monitoring.

Response to Villarreal and Markman

Dear Editor, We thank Drs. Villarreal and Markman for their thoughtful comments [1] on the clinical limitations of our recently published work describing a linguistically validated Spanish version of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) screening tool for aberrant medication-related behaviors [2]. The letter provides valuable clinical insight into the limitations of the linguistic validation process used in …