If the patient has a current diagnosis of addiction, this may need to be managed separately (by appropriately trained professionals) in parallel with ongoing pain management. Additionally, a past or current history of an addiction problem is a significant predictor of likelihood of running into problems when prescribing controlled substances for pain. A number of tools are available to screen for the presence of an addictive disorder. The CAGE questionnaire was developed to screen for alcohol misuse and has been adapted to screen for other drug use.38 The questionnaire is simple to administer and has been demonstrated to be both sensitive and specific as a screening tool. The Screening Tool for Addiction Risk (STAR) questionnaire is a validated tool that has been developed to evaluate addiction problems in chronic pain patients and includes questions regarding prior treatment in a drug or alcohol rehabilitation facility, as well as questions regarding nicotine use and treatment in another pain clinic.39
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