Using Screening Tools

Screening tools can provide a good baseline for monitoring patient behaviors, detecting aberrant behaviors, and determining the risk of long-term opioid therapy. Most patients in pain clinics will undergo a screening process that includes an opioid screening tool when long-term opioid therapy is being considered as an option. Some patients exhibit aberrant behaviors that can skew the health care provider's willingness to continue with opioid medications. Using tools to monitor the appearance and meaning related to the risk potential for using opioids will help the practitioner decide if opioid therapy for an individual patient has a favorable risk—benefit ratio.

Some of the simplest screens are the CAGE and the TRAUMA screen. The CAGE questions include:

■ Have you ever tried to cut down on your alcohol or drug use?

■ Have people annoyed you by commenting on or critiquing your drinking or drug use?

■ Have you ever felt bad or guilty about your drinking or drug use?

■ Have you ever needed and eye opener first thing in the morning to steady your nerves or get rid of a hangover?

The higher the number of positive responses, the greater the likelihood that the patient has a drug or alcohol abuse problem.

In the TRAUMA screen, the person's injury profile is assessed. To perform this screen the patient is asked the following questions.

Since your 18th birthday, have you:

■ Had any fractures or dislocations to your bones or joints (excluding sports injuries)?

■ Been injured in a traffic accident?

■ Injured your head (excluding sports injuries)?

■ Been in a fight or assaulted while intoxicated?

■ Been injured while intoxicated?

If the patient has a positive response to two or more of the questions in the TRAUMA screen, there is a high potential for abuse.

For any of these simple screens, if there is concern about the potential for addiction, medication misuse, or the development of addictive behaviors, using the more complex screens listed subsequently can help identify the magnitude of risk if opioid therapy is being considered. The more complex screens are as follows:

1. Screener and Opioid Assessment for Patients with Pain assesses for abuse potential using a 14-item self-report measure. This is a reliable and valid measure where a score of equal to or greater than 8 indicates a high risk of misuse or abuse.

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