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(197) Predicting opioid misuse with a brief screener of catastrophizing
Abstracts
The Journal of Pain
S25
with respect to the ADBI were calculated, as were coefficient alpha values. The sensitivity of the full-length SOAPP-R was 0.74; the specificity was 0.67. These values, respectively, were 0.74 and 0.70 for the 10-item short form; 0.73 and 0.70 for the 11-item short form; and 0.74 and 0.69 for the 12-item short form. All of the aforementioned forms exhibited a coefficient alpha at or above the standard threshold of 0.70. In 10-fold cross-validation, each of the above short forms exhibited sensitivity and specificity within 0.04 of those of the full-length SOAPP-R, with coefficient alpha values still at or above 0.70. It was concluded that these three short forms have sufficient potential to be tested in future prospective studies. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R03DA036683. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Data for this study were provided by Inflexxion, Inc.
the Cohen’s kappa coefficient. The score for the Catalan version of the Flesch-Szigriszt Readability Index was 46.32 (somewhat difficult and ready for a high school literacy level population) and the score for the Fernandez-Huertas Index was of 52 (fairly difficult and ready for a pre-University literacy level population). The Flesch-Szigriszt Readability Index score for the Spanish version was 54,61 (somewhat difficult and ready for a high school literacy level population) and the Fernandez-Huertas Index score was 60.02 (good for a population of 10-12 years old). The scores for the definition of terminology were of 54,59 (somewhat difficult and ready for a high school literacy level population) and of 59.73 (fairly difficult and ready for a preUniversity literacy level population). The mean kappa coefficient for the catalan version was of 0.79 (good level of agreement) and of 0.83 for the Spanish version (very good level of agreement). Mean kappa coefficient was obtained for each items of the ECS-CP in both versions achieving scores of good or very good level of agreement.
(197) Predicting opioid misuse with a brief screener of catastrophizing
(199) Pain characteristics before and after Chiari-1 surgery
R Gross, D Long, and S Cox; Department of Behavioral Medicine and
Stroke, Bethesda, MD
Psychiatry, West Virginia University, Morgantown, WV
Posterior headaches, often with neck pain, are common with Chiari1 (CH). CH with syrinx (SY) may include limb and/or trunk pains. The revised Short-Form-McGill-Pain-Questionnaire (SFMPQ2) scores intensity of 22 descriptors in 4 categories to characterize chronic pain. Categories are: continuous, intermittent, neuropathic and affective pains. This study characterized pain in CH with and without SY in surgical or non-operative treatment groups in comparison to changes in headache severity. Twenty-seven CH patients had clinical, MRI, and SFMPQ2 evaluations at baseline and 1 year later. Nineteen also had SY. Two-thirds had surgery. Headache improvement was graded as none-minimal, moderate, marked. Improvement in 18 surgical patients was: marked = 12, moderate = 4, and none-minimal = 2. Non-operated patients were: marked = 1, moderate = 3, and none-minimal = 5. All operated patients showed improved foramen magnum CSF flow. In both groups, CH patients without SY did better. Baseline mean SFMPQ2 score in each of the 4 categories was better in the non-surgical group. At followup, SFMPQ2 scores worsened in the non-surgical group and improved in the operated patients corresponding to differences in headache improvement. Amongst SFMPQ2 categories, improved Affective Pain scores tended to be associated with headache improvement. To a lesser degree, worsening Affective scores were more common with lack of headache improvement. These results demonstrate the benefit of decompressive surgery to improve CSF flow dynamics for CH headaches. Because CSF flow dynamics should be more abnormal in CH with SY than with CH alone, it is not surprising that headache improvement is better in CH without SY. In both groups, we also noted an increase incidence of chronic posterior cervical muscle spasm in those with lesser improvement. Other than the Affective score changes no consistent SFMPQ2 pattern distinguished one category of patient from another.
Opioid medications commonly are used to treat various pain related conditions and are often misused by patients. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) has been utilized in health settings for predicting opioid medication misuse. This study, examined the utility of the Catastrophizing Subscale from the Single Item Form of the Coping Strategies Questionnaire (CSQ3 Catastrophizing Subscale – ‘‘It is terrible and I feel it is never going to get better’’) to predict risk for opioid misuse on the SOAPP-R relative to the full scale Pain Catastrophizing Scale (PCS). The single item Catastrophizing Scale of the CSQ was selected as a more clinically useful tool for primary care settings to identify a modifiable risk factor for misuse. Patients were a clinical sample of convenience who were referred by medical providers for screening for possible long term opioid therapy. Data on 119 patients were used to determine the predictive ability of CSQ3 on SOAP-R score for both high risk (SOAP-R $ 22), and overall SOAPP-R score. The AUC, area under the receiver operator curve, which measures the ability of a variable or model to predict a binary outcome, for High risk SOAP-R with respect to CSQ3 was 0.72, which implies large predictive ability. Additionally, CSQ3 has an R2 of 0.30 for continuous SOAPP-R, again suggesting good predictive utility. However, when compared to PCS, CSQ3 has less utility, partial R2 of 0.014. Thus, CSQ3 does a good job of predicating SOAPP-R but is not as effective as PCS. These findings suggest a single question assessing for Catastrophizing has both clinical utility as an easily administered, scored and interpreted screener and, empirical validity in health-based settings as an initial screen for elevated risk for opioid misuse in chronic pain samples.
(198) Translation and validation of the Quick Users Guide of the Edmonton Classification System for Cancer Pain into Catalan and Spanish J Canal-Sotelo, N Arraras-Torrelles, R Gonzalez-Rubio, J Lopez-Ribes, E Barallat-Gimeno, J Trujillano-Cabello, R Fainsinger, and C Nekolaichuck; Supportive palliative Care Team. Hospital Universitari Arnau de Vilanova., Lleida, Catalonia, Spain
Pain is a highly prevalent symptom in advanced cancer patients. An accurate multidisciplinary approach is mandatory to achieve the best outcomes. The Edmonton Classification System for Cancer Pain (ECS-CP) is a reliable tool designed to classify difficult pain in cancer patients. Includes 5 categories (mechanism of pain, incidental pain, psychological distress, addictive behaviour and cognitive impairment). We designed the process in three different steps starting at the translation from the original in English into Spanish and Catalan, followed by linguistic adequacy and the back-translation from Catalan and Spanish into English. On the second step the analysis of the readability and intelligibility took place using the FleschSzigriszt readability index and the Fernandez-Huertas Index, throughout the INFLESZ freeware. In the third step we calculate the inter-rater agreement for qualitative (categorical) items using
F Cantor, J Skala, and J Heiss; National Institute of Neurologic Disease and
(200) Opioids and genetics: rs2740574 in CYP3A4 may impact the risk of opioid abuse, misuse, and/or addiction J Blanchard, N Anand, B Meshkin, S Kantorovich, and E Fung; Proove Biosciences, Irvine, CA
Oral opiates are metabolized by the cytochrome P450 system, a heme-containing, microsomal drug-metabolism superfamily. Differences in opioid metabolism have been implicated in the variability of individual response and efficacy of opioids and are thought to play a role in opioid abuse, misuse, and/or addiction. In this study we seek to determine if genes associated with the cytochrome P450 system and the mesocorticolimbic system are associated with increased risk of opioid abuse, misuse, and/or addiction. A retrospective, cross-sectional study was carried out on 908 chronic non-cancer pain patients from research sites across the United States taking opioid analgesics. 258 were diagnosed with opioid abuse, misuse, and/or addiction based on ICD-9 CM codes and 650 served as controls. Genotyping for 85 single nucleotide polymorphisms was performed using pre-designed TaqManâ single nucleotide polymorphism (SNP) Genotyping Assays (Thermo Fisher Scientific).
The Journal of Pain
S25
with respect to the ADBI were calculated, as were coefficient alpha values. The sensitivity of the full-length SOAPP-R was 0.74; the specificity was 0.67. These values, respectively, were 0.74 and 0.70 for the 10-item short form; 0.73 and 0.70 for the 11-item short form; and 0.74 and 0.69 for the 12-item short form. All of the aforementioned forms exhibited a coefficient alpha at or above the standard threshold of 0.70. In 10-fold cross-validation, each of the above short forms exhibited sensitivity and specificity within 0.04 of those of the full-length SOAPP-R, with coefficient alpha values still at or above 0.70. It was concluded that these three short forms have sufficient potential to be tested in future prospective studies. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R03DA036683. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Data for this study were provided by Inflexxion, Inc.
the Cohen’s kappa coefficient. The score for the Catalan version of the Flesch-Szigriszt Readability Index was 46.32 (somewhat difficult and ready for a high school literacy level population) and the score for the Fernandez-Huertas Index was of 52 (fairly difficult and ready for a pre-University literacy level population). The Flesch-Szigriszt Readability Index score for the Spanish version was 54,61 (somewhat difficult and ready for a high school literacy level population) and the Fernandez-Huertas Index score was 60.02 (good for a population of 10-12 years old). The scores for the definition of terminology were of 54,59 (somewhat difficult and ready for a high school literacy level population) and of 59.73 (fairly difficult and ready for a preUniversity literacy level population). The mean kappa coefficient for the catalan version was of 0.79 (good level of agreement) and of 0.83 for the Spanish version (very good level of agreement). Mean kappa coefficient was obtained for each items of the ECS-CP in both versions achieving scores of good or very good level of agreement.
(197) Predicting opioid misuse with a brief screener of catastrophizing
(199) Pain characteristics before and after Chiari-1 surgery
R Gross, D Long, and S Cox; Department of Behavioral Medicine and
Stroke, Bethesda, MD
Psychiatry, West Virginia University, Morgantown, WV
Posterior headaches, often with neck pain, are common with Chiari1 (CH). CH with syrinx (SY) may include limb and/or trunk pains. The revised Short-Form-McGill-Pain-Questionnaire (SFMPQ2) scores intensity of 22 descriptors in 4 categories to characterize chronic pain. Categories are: continuous, intermittent, neuropathic and affective pains. This study characterized pain in CH with and without SY in surgical or non-operative treatment groups in comparison to changes in headache severity. Twenty-seven CH patients had clinical, MRI, and SFMPQ2 evaluations at baseline and 1 year later. Nineteen also had SY. Two-thirds had surgery. Headache improvement was graded as none-minimal, moderate, marked. Improvement in 18 surgical patients was: marked = 12, moderate = 4, and none-minimal = 2. Non-operated patients were: marked = 1, moderate = 3, and none-minimal = 5. All operated patients showed improved foramen magnum CSF flow. In both groups, CH patients without SY did better. Baseline mean SFMPQ2 score in each of the 4 categories was better in the non-surgical group. At followup, SFMPQ2 scores worsened in the non-surgical group and improved in the operated patients corresponding to differences in headache improvement. Amongst SFMPQ2 categories, improved Affective Pain scores tended to be associated with headache improvement. To a lesser degree, worsening Affective scores were more common with lack of headache improvement. These results demonstrate the benefit of decompressive surgery to improve CSF flow dynamics for CH headaches. Because CSF flow dynamics should be more abnormal in CH with SY than with CH alone, it is not surprising that headache improvement is better in CH without SY. In both groups, we also noted an increase incidence of chronic posterior cervical muscle spasm in those with lesser improvement. Other than the Affective score changes no consistent SFMPQ2 pattern distinguished one category of patient from another.
Opioid medications commonly are used to treat various pain related conditions and are often misused by patients. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) has been utilized in health settings for predicting opioid medication misuse. This study, examined the utility of the Catastrophizing Subscale from the Single Item Form of the Coping Strategies Questionnaire (CSQ3 Catastrophizing Subscale – ‘‘It is terrible and I feel it is never going to get better’’) to predict risk for opioid misuse on the SOAPP-R relative to the full scale Pain Catastrophizing Scale (PCS). The single item Catastrophizing Scale of the CSQ was selected as a more clinically useful tool for primary care settings to identify a modifiable risk factor for misuse. Patients were a clinical sample of convenience who were referred by medical providers for screening for possible long term opioid therapy. Data on 119 patients were used to determine the predictive ability of CSQ3 on SOAP-R score for both high risk (SOAP-R $ 22), and overall SOAPP-R score. The AUC, area under the receiver operator curve, which measures the ability of a variable or model to predict a binary outcome, for High risk SOAP-R with respect to CSQ3 was 0.72, which implies large predictive ability. Additionally, CSQ3 has an R2 of 0.30 for continuous SOAPP-R, again suggesting good predictive utility. However, when compared to PCS, CSQ3 has less utility, partial R2 of 0.014. Thus, CSQ3 does a good job of predicating SOAPP-R but is not as effective as PCS. These findings suggest a single question assessing for Catastrophizing has both clinical utility as an easily administered, scored and interpreted screener and, empirical validity in health-based settings as an initial screen for elevated risk for opioid misuse in chronic pain samples.
(198) Translation and validation of the Quick Users Guide of the Edmonton Classification System for Cancer Pain into Catalan and Spanish J Canal-Sotelo, N Arraras-Torrelles, R Gonzalez-Rubio, J Lopez-Ribes, E Barallat-Gimeno, J Trujillano-Cabello, R Fainsinger, and C Nekolaichuck; Supportive palliative Care Team. Hospital Universitari Arnau de Vilanova., Lleida, Catalonia, Spain
Pain is a highly prevalent symptom in advanced cancer patients. An accurate multidisciplinary approach is mandatory to achieve the best outcomes. The Edmonton Classification System for Cancer Pain (ECS-CP) is a reliable tool designed to classify difficult pain in cancer patients. Includes 5 categories (mechanism of pain, incidental pain, psychological distress, addictive behaviour and cognitive impairment). We designed the process in three different steps starting at the translation from the original in English into Spanish and Catalan, followed by linguistic adequacy and the back-translation from Catalan and Spanish into English. On the second step the analysis of the readability and intelligibility took place using the FleschSzigriszt readability index and the Fernandez-Huertas Index, throughout the INFLESZ freeware. In the third step we calculate the inter-rater agreement for qualitative (categorical) items using
F Cantor, J Skala, and J Heiss; National Institute of Neurologic Disease and
(200) Opioids and genetics: rs2740574 in CYP3A4 may impact the risk of opioid abuse, misuse, and/or addiction J Blanchard, N Anand, B Meshkin, S Kantorovich, and E Fung; Proove Biosciences, Irvine, CA
Oral opiates are metabolized by the cytochrome P450 system, a heme-containing, microsomal drug-metabolism superfamily. Differences in opioid metabolism have been implicated in the variability of individual response and efficacy of opioids and are thought to play a role in opioid abuse, misuse, and/or addiction. In this study we seek to determine if genes associated with the cytochrome P450 system and the mesocorticolimbic system are associated with increased risk of opioid abuse, misuse, and/or addiction. A retrospective, cross-sectional study was carried out on 908 chronic non-cancer pain patients from research sites across the United States taking opioid analgesics. 258 were diagnosed with opioid abuse, misuse, and/or addiction based on ICD-9 CM codes and 650 served as controls. Genotyping for 85 single nucleotide polymorphisms was performed using pre-designed TaqManâ single nucleotide polymorphism (SNP) Genotyping Assays (Thermo Fisher Scientific).