Open AccessMonitoring Opioid Adherence in Chronic Pain Patients: Assessment of Risk of Substance Misuse
Author(s) -
Daneshvari R. Solanki,
Dhanalakshmi Koyyalagunta,
Rinoo V. Shah,
Sanford M. Silverman,
Laxmaiah Manchikanti
Publication year - 2011
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2011/14/e119
Subject(s) - medicine , chronic pain , cancer pain , opioid , medline , cochrane library , addiction , substance abuse , pain medicine , alternative medicine , psychiatry , intensive care medicine , anesthesiology , receptor , pathology , political science , law
Background: Use of opioids for chronic non-cancer pain (CNCP) has increased in recentyears because this pain had been undertreated. There was also a simultaneous increasein misuse and abuse of opioids. Deaths due to such abuse and misuse also have risenas seen in the many reports published every day in local papers as well as in the medicalliterature. So, it is imperative that patients who are prescribed these medications bemonitored for adherence so misuse and abuse can be curtailed and opioids are availableto those who genuinely need them for chronic pain control. There are various screeningtools available to monitor such adherence, and there is an abundance of literature aboutit in addiction and psychiatric medicine. There is, though, a paucity of such literature asapplied to pain medicine.Objectives: Our objectives for this review were twofold. We wanted to identify whichscreening tools are available to monitor opioid adherence and we wanted to see if therewere prospective comparative studies of these tools to identify a single best tool that canbe applied to all chronic non-cancer pain patients managed with opioids.Study Design: We did a review of the current literature about monitoring of opioidadherence. We also looked at their use, validity, and comparative studies.Methods: We performed a literature search using PubMed, EMBASE, and the Cochranelibrary. The search was conducted using the terms opioids, non-cancer pain, monitoring,and adherence. The databases from 1996 to November 2010 were reviewed. Thesearch included prospective and retrospective studies, review articles, and FDA records.Bibliographies and cross references were reviewed when deemed appropriate.Conclusion: We found 52 publications, of which 22 met the criteria to be includedin this manuscript. We found only one study that was prospective, and compared thevarious screening tools that are available to monitor opioid adherence. In the majority ofthe studies the number treated was small. There was not a single screening tool that canbe applied universally to all patients who are on opioid therapy for chronic non-cancerpain.Key words: Opioids, chronic pain, chronic non-cancer pain, opioid adherence,monitoring of opioid adherence, controlled substances, prescription monitoringprograms, screening tools